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ICE USE: Permit No. .APPLICATION FOR SANITATION PERMIT 7 ---------- , ____ _ (Complete in Duplicate) Date Issued ------ ---- -"-•- This Permit Ex ares 1 Year From Date Issued -.--------- permit to construct and instpl],t�he yw CA described. Application is hereby made athe Mance witSan h Countyuin aordinance D1NoC 549 a P �V) {�t E This application is made m p " " l �. � -- 5-110� Pc1a D�__ tt�_..."fir c�1N A ... ---------- 4q J08 ADDRESS AND LOCATVON_ - En Phone. Owner's Name._--- --- `" =:- p( -- Address.-•-------•I-`�1-5-Y....... ------;��-��- �. Phona'i/T - ------------------•--- •- Other ❑ �x------ Motel ❑ Contractor's Name-----_.. Trailer Court ❑ artment House Commercial ❑ Installation will serve: Residence AP _ Q�_-x__l_J�. �---•••---•----••------ JJ ze Number of living units: --1.--- Number of bedrooms._.-- -. NLmbVerf.baths,- ateroTable _16.. ft•PrivateDepth To W 1 c € Water Supply: Public system ❑ Commun ty�Systern ❑ Clay Adobe❑ Hardpan❑ I Gravel Sandy Loam e Clay Loam❑ Y ❑ Character of soil to a depth of 3 feet: Sand ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No Iication Made: (If yes, } No Previous App� g TY_P-E_OF_INSTALLATION:AND-SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer iwvailable within 200 feet-) Mate ial.. .- -- �VQq� b ---- Capacity.- QQ 0- Septic nk: Distance from(nearest wall•= --=-Distan a fr fa tiL g d depth"----- ------------- P tY' �- Size X_Y V' i No. of compact ants_.__-" .- ,�-...._. ion -------_- Istance to nearest !ot Vine��._ i Dis osal Field: Distance from nearest well---570 �enath of reach 1"ne om at Width of trench.__"_r�� Number'of lines#. 9 r! �. � Depth of filter material___ --•--•-- Total length-- Disposal •- p Type of filter materlal..__/_�-Q - p Seepage Pit: Distance to newest well_"--.-_"---".--------Distance-from foun lation Diameter-----------------------Distance toDepthst lot line__'._-.-.:-'._--- ❑ Number of pits-I--------------------Lining material- ------- - _ ---•----- -----...-_. Distance from I arest Distancewell----------------- from foundation--------------------- --:--------- _-LinuidCapacitya l•-- -- gals. Cesspool: Depthq ---------------- ❑ Size: Diameter._.-. Distance from nearest well---------------------- ------------ -�-�- "-�----Distance from nearest building------------------------------------'"-' Privy: }------------------•-----•----------•---•------------------------------------- ❑ Distance to nearest lot line----------------- ------- -- f #i --------------, ••---•-------..---•-----•--------- ------••------•-•---- ----•----- Remodeling and/or repairing escr+ e ----------------------------------------------------------- -----•------ ! t --- --------------------------------- -------------i•-•-------------------------------------------------------------------- -----------•-- -- --- have prepared this app lication and that the work will be done to accordance with San Joaquin County I hereby certify that P p ordinances, State laws, and rules and re do f-#h n Joaquin Local Health District: ) F -------(Owner and/or Contractor) --------------------- -- .""-- - - .. C Si ned - -w-- �----- ----------------------- _.- . - �. _ .,.,� n, showinsize of lot, location of g system I�tion to wells, [Plot plan, buildings, etc., can be placed on reverse side) FOR DEPARTMENT USE ONLY 1 -------------- TDATE------��.--- -��--r-`Ak7---`----- `� fi_� � APPLICATION ACCEPTED BY--"----- :•-i- -= ------------ �-------- DATE-------------------------------•---------------------------- REVIEWED ------•-------•-----------REVIEWED BY ----- BUILDING PERMIT ISSUED--------------------------------------------------------- - ------------------••--------- - . Alterations and/or recommendations------------------------------------ ---- - - ---•- -----------------------phfh __T Cf` ------• - -------- ; - ------------- - -- � s " Date---- - � 6RNAL INSPECO ---•�--- --- - ----- ------•• ---- -- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 144 SYcamer!Street t 305 wast 9th Street 139 South American Street 300 west Oak Street Tracy,California Manteca,California Stockton,California Lodi,Gatifam10 5 E5 9 REVISED 8-59 2M 5-62 ATLAS N