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FOR OFFI15 - ----------------------------------- ------------------- V.------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..417 1�, --------------------------- --------------------- (Complete in Duplicate) ----------- ---------------------------- --------- I This Permit Expires I Year From Date Issued Date Issued ....... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made ip compliance with County Ordinance No. 549. 19 N TEE=C t+ DE JOB ADDRESS AND LOCATION-__. Ali ..FOD-T- pf4-------------_--------- .....Why......350-0....... -----oF-------A-vi------i. Owner's Name-----------1 ........ e----=ePA ---------- Phone.................................... -------------- Address1..cT.. ............. M..Z:Z�........1_30)(_,1..,_2 ' MANTE 0-------- ..... ------------•---•-•--•-••---•••---. ..........................................----------------------------- Contractor's Name____________________ ------------------------------------ Phone-----..---------.................. -------------------------------------------------------- Installation will serve: Residence ga' Apartment House, [] Commercial F] Trailer Court ❑ Motel F] Other 3 Number of living units: .4--- Number of bedrooms --Number of baths I.... Lot size ....3_5�.... ____3_`f-Q----------- Water Supply: Public system E] Community system Private Za- Depth to Water Table /57ft. Character of soil to a depth of 3 feet: Sand JD-' Gravel E]_-Sandy Loam El Clay Loam 0 Clay C] Adobe 0 Hardpan E] Previous Application Made: (If yes,date--------------------) No �' New Construction: Yes P�No E] FHA/VA: Yes F1 No R j TfAf QF INSTALLATION AND SPECIFICATIONS:. (No septic tank or cesspool permitted if public sewer is available within 200 Septic Tank: Distance from nearest weli-5c.-,---Distanqe from foundation------ -------Material--- ....... 2 pei:90 4f2o ..... Si Capacity... ------- No. of compartments____ ze,._/X1.P.X_5--- Liquid depth..... Disposal Field: Distance from nearest well----50---.-Distance from foundation.--, ----Distance to nearest lot-tine ;P I Number of lines--------- -----------------Length of each line....../_0�2-------------Width of trench.- 3k'!.................. It .122Z7 Type of filter material___ Depth of filter rhaterial----- -------Total length___________---- , _z... ---- --�t5 Seepage Pit: Distance to nearest well__ __________________Distance from foundation....................Distance to nearest, lot line.................. 1771 Number of pits----------------- Lining material-----------------------Size: Diameter__._____________-_-__Depth___-,__--___-__.___-____.____._ V11 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____._______-______-__-_--___________. 1P El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-------_-------------------gals. Privy: Distance from nearest well--.------------------------------------ ---------Distance from nearest building--------------------------------------------00 ❑ Distance to nearest lot line----------------------------- ----------------------------------------------------------------------------------------------------------- 0 Remodeling and/ori repaKnj '(describe):---------------------------- ------------------------------------------------- ----------------------------------------------- ------------------------------------------------ --------------_----_ -------------- -------�.4tnt4-------I.. ---------------------------------- ------ --------------------------------1-------------------------------------------------------------------...........................------------------------------------------.......................................I------ ------------------------------------ --------------------------------------------------------------------------------------------------------- -------------------------------------------------------- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sf9fe laws, and rules pnd I tion f the San Joaquin Local Health District. (Signed)...... --..z------- - - -------------- ----------- -------------------- --------------------------------------------- -----(Owner and/or Contractor) By:................................................................--------------------------------------------------------- ��_77716_r------—-------- ----------------------- ----- -------------- (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----- ---------------------------------------------------------- DATE..........5Z_..•--2 4-V,--------------------- REVIEWEDBY------------------------------------------------------------------- ---------------------------r.............................. DATE-----------------------------------7--------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------—-------------------------------------- DATE---------------------------------------------............... Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ -----------------------------------------------------------------------------------------------------------------------------------------------............... megu a i Dris Z_-j- ------------------------------------------------------------------------- -- ------------------------------------------------------------------------------------------- ----------------------------------.................. ------------------------------------------ ...... --- ----------- --- --------- ------------------------------------------------------------------------------------------------------------------- ----------- -------- ........... ----- ---- ------ -- - -- ----------------------------------------------------------------------------------------------------------- ...... FINAL INSPECTION-13-Y. -------- -- ---- Date------------- x------------------------------•-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California vs 9 RrLviritto 9-59 3M 3--63 F%P.ra.