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� Permit No. __.1�-•�-•7•� APPLICATION FOR SANITATION PERMIT S ll (Complete in Duplicate) � Date Issued ___ it to construcf and install the work herein described. Application is hereby Imade to the San Joaquin Local Hdealth DkNoc 5for a perm pP This application is made in compliance with County JOB ADDRESS AND<L CATION__________ ___ - p ¢D - Owner s Name----- - - •----- ------•-- ----- --- --------- ----- ---------- 1 51 Address ' ,13�.,. "..� ---- Phone- Contractor's Name----------- ---- •---- Motel ©, Other ❑ art nt House Commercial ❑ Trailer Court ❑ Installation will-`serve: +'Residence AP Q Qo------------------ /- Lot size ----- Number of living units:___�__ Number of be __/--- Number of baths ---/--- lft a . Private Depth to'Water Table.! Water Supply:--Public system. Community.sysfiern ❑ ❑ p Cla Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet:. Sand ❑ ' Gravel ❑ Sandy Loam ❑ Y Previous Application Made: Yes ❑� No New Construction: Yes ❑ N FHA/VA: Yes ❑ No TYPE,OF INSTALLATION AND SPECIFICATIONS:- r {No septic tank or`cesspool permitted if public sewer is available within 200 feet.} - ... ••• Septic Tank; Distance from nearesr well__=_..--------.Distance from foundation__. _ ___- __- Materia :.____ ___ ._ _ " - Size_ ---- ----- -----Liquid depth----------------- --- -- Capacity. - ❑ Na. of compartments Dispos'I "l�eldD e est ei;'.. _.-- Distance from foundation-------------- -___-___ __'____--Distance ton arest lot me_-____ � ' ��.__ ------- ------ �--.Width of trench----------------- ---= 1- --- _d.---_______ Length of each line__ ,______- ❑ Number of Imes g i _ Type of-Vier„mate ialf ___� -`•Depth a„ �n'atenal_ _.__ _ - ---dotal lengt ,. /�}} 74 � _ Dista cn a.to near�t lot line_-� / ,�-. �i� _ i` ' i Mi Distance to nearest well_ -`-Dis#ante from fo anon__ ____________ r Seepage Pit:. Size: Diameter--- ---- ----Depth-_:--- ----- ---- Linin material�, �7` - { N�mber of pis ;--------- g . i . ,. � ---s-- ----`-Dis#ante from faundafiion----------- ------.Lining materia------------------ -------- ---�---= Cesspool: Daze Diameter neae sfi well Depth------------------------------------ ------------Liquid capacity'.,----------------------gals. �I p S ;- ;� Distance from nearest,,bui ing-'_------ --- 000 Distance from nearest well,- Privy: - _. Privy: - - _.. - ... , -------------------------- ❑ -:-e----Y-°Distance to nearestlo' line_- __ _. _ - .� - ` �l,�_ - - --- --- --- ------------------------ Remodeling and/or repairing (describe.__ ;,� -- ------------------•_------ -. - r.. l # _ _._. t ---------------- ��: ----------------------- p - - U -=-- - ---------- M - ... --------- - -- ark will be done' n_ ". � '_ ------------------ ------------ = : actor nice with San• again aunty I-hereby-certify that I have }irepared this applica#ion and that F�he w h. r:� of the San Joaquin Local HealthDistrict. ordinances to la rules �:� egu anon _ - {owner and/or Contractos� f----- — (Signed) - -- ----- -- ------- -'---- ---------- (�Itle),� [Plot plan•, showing size of lot�lo ati M of system,in relation to wells, buildings, etc., can be plod orti�reverse side z r t FOR DEPARTMENT USE ONLY , l i _ _._DA1E6'�4--1-----------�---�--_------ APPLICIGN-AG G,EPTt w_.x �•-. ---------------------------- ---------•----------------- -- =�--- DATE REVIEWED` B --------------------- ----------------- -• ---------------------------------------0--•-'--- --=•--------- ----- DATE-----------------------------------------------•-------------- BUILDING --=------ --•BUILDING PEkWT ISSUED------i------=- --- �W �+ Alterationsran�d/or reco d" ions . $p.�f/J 'rte h 1 11 ' ' ------------ ' �.` ---------------------------------- - _ ------- -------------------------------------- ----------------------------------- -------- '" - Date _ -----------------------•- .. _: FINAL ,INSPECTION' BY:.-=°-"-- = == SAN JOAQUIN LOCAL HEALTH DISTRICT ` , 132 Sycamore Street 814 North "C" Street 13D South American�Stree r 34o West Oek.Street:��`�-' Manteca, Celifornie Tracy, California Stockton, California Lodi, California' ES-9-2M , Revised i-57 F-p•Co• _