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Permit No. .___.. .._ APPLICATION FOR SANITATION PERMIT �f�--�--- '-7[ (Complete in Duplicate) Date Issued ______�� -�--� Application is hereby made tq..the San Joags}� ®ca[Health District for a permit to construct and install the work herein described. This application is made in compkant rij C� nnyy Ordinance No. 549. JOB ADDRESS MANN jD LOCATION ` : ----- r.r�l,�ti�� 1__ /� Owner's Name_,:. ---------�-'t---'-1'4•-�r�re ---------------------------------------- - ----------------------------------- Phone- O�` -q � x_� Address------._ ' Contractor's Name-- `,A1&4------- aJ� ------ Phone. Installation will serve: Residences Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: f___ Number of bedrooms 41__ Number of baths Lot size ____--�__�Cr-_-____________________________ Water Supply: Public system ® Community system ❑ Private rX Depth to Water Table 3 ft.' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________Distance from foundation___, ________.Material----- --------_-----------------------__________- © No. of compartments_____ -----------Size----_3_-_X:f`-C--`t ---Liquid depth----�j ---------Ca pacitY---- e�.-I Disposal Field: Distance from nearest well-_&----------Distance from foundation___-X4�..........Distance to nearest lot line-__r_P---.- Number of lines---------X--------------------Length of each line----------1/49-------------Width of french---2 --`'-------------__---_ r Type of filter material---- �'_ k_rDepth of filter material____J_K_4'____.___Total length--------- _____________________--____ 4 Ste Kf: Distance to nearest well_____ 0_________Distance from foundation____.-____ istan/ce to nearest lot line: ___.----- _______Q_C" N 0 Number of pits________[-------------Lining materialA-Size: Diameter__- __1� # _l Depth_..___-_-0_._______--__ r~r � � W Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____________-------._______________- ❑ Size., Diameter----------------------------- --------Depth--------------------- --- --- ---------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____-__________________________----_____. ❑ Distance to nearest lot line--------- ----------------------------------- - --------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)---- ----- --------------- -------------------------•--------------------•-------------------------------------=----------------------------------------- ------------------------------------------------- ---------------------------------------------------------------------------------------------------•-•---------------------------------------------•------------------------ +r► ------------------------------------------------------------------------------------------------------------------------------------------•--•----.....--.-------------------------------------------------------------------- ----------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) 71 _ ter__ ------------ (Owner and/or Contractor) -------------------------------------------------------- ------- --- By:---- ------------------------------- _(------C- l -----------------------------------------------------------{Title]------p ''e j' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------77K,0_-,t------------------ ------------------------------------ DATE---------C? 5_7----------------------- REVIEWEDBY----------------------------------------- --- ------------------------------------------------------------------------------ DATE---------------------------------------•-------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------—-------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:-----------------------r----------------------A----•-------------- ------------------- -------------------------------------------------- ------------- --------•------------------ ----------•--------- -------------5�t_3-------- .............. ------------------------------------------ n -----e ; _ 1J- y"S --------------------------------------- ------------------- - -- ------ ---------------------------------------------- ------------------------------------------------------------------- Date--- } �� --45 FINAL INSPECT[ Y:. U �(/ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Strest 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21A Revisea 1-57 F.P.CO.