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OR OFFICE USE: ,l ' ----- %�8� ----------- ---_X APPLICATION FOR SANITATION PERMIT S ---- ------ ---- " -�-" -�-- --�-"" -- --- - (Complete in Duplicated --}} - -----.- Date Issued ---�---a'•i- --� _ �2__Q -- --,_- This Permit Expires 1 Year From Date Issued .� -- --- -- �5 Application is hereby made to the San Joaquin �atcaOHdenat Cbi�oc 5f 9r a permit #o construct and install the work herein describe . This application is made in compliance with County ---f- ------------- JOB ADDRESS AND OC N__.-_�_,/_- # ----------- JOB - ---------- - ---- - ---- Phone---- --• -• Owner's Name.-_____ i.-- ----ti / o -------- Address-__ ------- = --•--... . \ -----�� i ------ Phone_";. Contractor's Name__-- El Installation will serve: Residence [ Apartmenf ouse ❑ Commercial ❑ Trai4er Court Motel El Other l -- - ----------------- Number of living units: -�__..- tuber of bedrooms _ ___- Number of baths -____-- of size --- --- ---- ----- - i Depth to Water Tabl j-O-_ ft. Water Supply: Public system Community system ❑ Private ❑ p Cla Loam ❑ Clay Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Y No FHA/VA: Yes ❑ No ❑ Previous Application Made: (if yes,date.. -- -} No ❑ New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S� tsc T Distance from nearest well -------- Distance from founaation_.__--___---------Material_.__.______.-."----" .------- p Y•--=-•- ---= No. of compartments..----------------------Size--------------------.-----------Liquid depth --•----- ------- --------Ca aci# I Q-.----.Distance to nearest lot line-----( ----.-.- osa e : Distance from nearest well -. 4� Distance from foundation___- _.__-- ,� W,Tp _Len th of each linP�--��--f-------�---Width of'trench_-�e`-- --`----3r-----•-- , Number of lines---- ---- - -- --- . g� �0.;_-^To#aa ctonearestlot I e --- --------.+ `< . . Type of filter material-- ---- -Depth of filter materia!_:_.._-�-- length Distance to nearest well_ �----------------Distancgrom f undation_, -----------"--- lam P. # -----Size: Diameter.= p Humber of its-_# g _. P A ------------------------ 1� _--___.__Lin materia_.�_ Distance from nearest well.----_-----. ---Distance from ndation_- --------------Liquid Capacity- ---------------- -----�*gals. Cesspool: - De W--------------- ' ❑ Size: Diameter P Distance from nearest well------ F-- 4 --------- ,Distance.from.nearest building---------------- ------------- ------ Privy: ----------- --------( --------- --- --- -- -------- -------- =------ --- -----------------•-- .._' r Distance to nearest lot ine--------..._....:........ ----------------------- r e:---- - ------------------- A-------- ------•------------------------------------------- ------------- Remodeling and/or repairing (describe): -----------------------------------------------, . .. ----------------------------'---------- ------------------------------------f-_-- _-__------____ - _________________________________________________________ �w - ---------------------------- .. j --------------------------------------------------------------------------- -- a :- . prepared --------------------------- ------- - _ ; _ " = I hereby certify----- that ave re ared this application and_thet the work will be done in accordance with San Joaquin County, ordinances, State laws, ales and regulations of the S n Joaquin Local Health District. t = -..--(Owner and/or Con . 'r (O ner a d/o tractor) ------------------ ----------- ---------- f (Signed)--------S�P71�""f`A1i4 S6EiVirE Title k - `ALor6 -------------- - ----- = ------ (Title) ----- - ---- ----- ------------E--------- By_-__291 E MinerA7►@�_-- , [Plot plan, showing size of lot, location of system in relation wells, buildings, et ., can be plated on reverse si e. [ FOR DEPARTMENT USE ONLY l I DATE-- ._7- _" r— ----------- --------- APPLICATION ACCEPTED BY- --=-- -------------- ------ --- --------- DATE-------- ---• ------------------------------------r REVIEWEDBY------------------------------------------- --------------------------- ------ D TE_ --------- -- - + BUILDING PERMIT ISSUED----------- --------------------- ------- -- -------------------------------- -7-:7_ -�. L- '-----------------_---------------------•-------------- ----------- Alterations and/or recommendations:__-" --- - _ --..- --------- - f ----------- - ------------------- ----- 4 --- ----- ------------------- --- - z r ES --------------------------------------- at FINAL INSPECTION :- - ----------- ---- ---- -- -- -- --- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT fL 124 Sycamore Street 205 West 9Th Street 1601 E.Hazelton Ave. 300 West Oak Street Manteca,California Tracy,California Stockton,California Lodi,California F.P.CII.