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FOR OFFICE USE: "� 7 �-- Permit No. ..�-� 1 " "" APPLICATION FOR SANITATION PERMIT 1� --- ---- ------------------- (Complete--- -------------"" Com lete in Duplicate) Date Issued -------- -- This Permit Ex ires 1 Year From Date Issued Application is hereby made to the San JoaquinLocal Health District for a permit to construct end install the work herein described. This application is made in compliance with County � � �(pp �� �b 0 w� � - i ''2'�.E Sr•4 ---- ----------------•---------------•----------- JOB ADDRESS AND LOCATION---- ------- - - ------ Phone__.__.__.---.--•------ ,f� r �_ ) Owner's Name---------- -- ------------•-•------------------------- ._._ r -•------------------- Address .- Phone. Contractor's Name------------- Other ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Installation will serve: Residence Apartment House ❑ of baths Lot �Q Number of living units: _/--- Number of bedrooms Y-- Number ""-- size ff __ Depth to Water Table (4P ft. Water Supply: Public system F1 Community system Private ❑ p Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y FHA/ /� o VA: Yep` Application Made: (if yes,date--------------------7 No ® New Construction. Yes �o ❑ Previous App' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �C �� �p-----Maferol_----- -- iw -Septic Tank: Distance from nearest well___-'-~'------Distancgm found*ion___._-_ -- Capacity_. ---;h Size_ _ -li�� LiquEd depth E _ f No. of compartments_____ n -- i ,� ..._.. Distance to nearest lo` line47-1- Distance - Disposal Feld: Distance from nearer well-_ _`^"..__---Distance from foundP�tion___ -Width of trench -------w----�5-�------- ,L. Length of each finelvgl!--- Number of lines--------- Dep -Total len th--1,-�P-------------------------•- Type of filter material_ �;� th of, filter rnprial--" -- -------� g �- _Dista�e to nearest lot he- ------------- Seepage it: Distance to nearest well..--... -------Distance from foundation___ --•----- De th_ -" je- ----�. - Gt _.Size: Diameter__ , -- s Number of pits _-._______Lining mate - Cesspool: Distance from nearest well__...___"____.__Distance from foundation-------------------- material_...___"-_.____"----------------""-•-. 1• ---. ian -----Liquid Capacity---------------------------gals. ❑ Size: Diameter-------------------------------- Depth - Distance from nearest well--------------- Distance from nearest building-------------------------------------- Privy- h ------------------------------------------ -- ----------•------------------ --------------------------------------- ❑ Distance to nearest of ine._.--------------------- r _.. - --- •---- -----• l Remodeling and/or repairing (describe):-------- ---- --------------------------- -- ---------- ------------------------------ --------------------------------------------- ---------------------- -------- - ----------- --- - -- --- - -------------------------------•---------- -----------�-----------'c-.r-'R-•--_---;:----------------------------------- ---------------------------------------------------- I hereby certify that I have prepareduthisanapplication the San Joaquin the work cal Heawill lth Dior ctn accordance with San Joaquin County ordinances, State laws, and rules and reg $ of Contract [[�/��f L ----- --T----------------------------------------- �Q --'fit.. --- (Signed)----- --- . -- —" - - -------------------- (Title) L� i � �............... By:------------------•-------------------cat -- -- ------- --- --- -- ---on of syr+em ' anon to"wells, buildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, lo FOR FOR DEPARTMENT USE ONLY ----- l------------------------- DATE-- --------- ------------------- ` • �— APPLICATION ACCEPTED BY--- �----------- ----- ------------------------------ - --- ------------------------------------ DATE------------------------------------------------------------ ----------- --------------------------------------------- REVIEWEDBY------------------------ ---------------- ----------- ---------- ------- ------ DATE---------------------- ----------------------------------- BUILDING -------- ------------------------ BUILDINGlPERMIT tISSUED------------------------ -----------f---- -R-�----- __. __.__Al+ ations and/or recommendations: _ --- ------ — ~ _ ----------- 7 --- 2 -- -----------c' ----�-r-- - ---- ----------------------------- ----------------------- ------ ---- ----------------- Date--------------------------- ------------------------ FINAL INSPECTION BY---------------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nazolton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Manteca,California Tracy,California Lodi,California Stockton,California , ES 9 R£VIBEO B-59 3M 3•'63 F.P.r U- v