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APPLICATION FOR SANITATION PERMIT Permit No. .,, - -�--0_ l (Complete in Duplicate) �- Date Issued �+ I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. _pliance with County Ordinance No. 549. 2�3- 3%0_�,,y � ES AND LOCATI �£ � JOB ADDRESS is.made `oN .NQrth-_Weft Coffer Rhyl© __ ve: , & Willard S � s------------------------------ �L, Ted H. Creswell Phone_--53__8M--_-_.____-_----_--- Owners 327 POWnr----�v-----------•---------------------------------------•-------------------------------------------------------------------- Address------------------ --------------- Manteca Mail -P. 0. BOX 512 Manteca Bus. 99 - - - - - -------------------------------------•------------------•-••---------------------------------------------- ,I 1 i Confractor's Name__CSMA.9S__II 4ti -ng---8s.._ovm---0oatr_rS_Ctor----------------------------•----------------------- Phone---------------.------------------- Installation will serve: Residence [# Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Ihl____ Number of bedrooms ----3- Number of bathsa g___ Lot size __0214,5_________________________________________ Water Supply: Public system �❑ Community system El Private Depth to Water Table4-____6rt. (Varies Character of soil to a depth of 3 feet: Sand] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ , ® i i� Previous Application Made: Yes ❑ No E New Construction: Yes No ❑ �i TYPE OF INSTALLATION AND SPECIFICATIONS: { ,I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance frYom nearest well___6j Distance from foundation 1©E_________-Material____ __Reinforced Concreve' _ ---------------------- No. of compartments------------------ -------Size---------.-----.- q p P y- ---------------Li Liquid depth acit SOC--------- Disposal Field: Distance from nearest weli_�J_3P_ ._.Distance from foundation_10:j----------Distance to nearest lot line__5T______ . lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- 1 Typebof filter material__Dr.___RO_ckDepth of filter t riAL n_13T-------Total length___180______________________________ Seepage Pit: Distance too nearest well-----------------------Distance from foundation________-___.._____.Distance to nearest lot line________________ ❑ None Number of� pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------------------ -- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- Size; ________________________________ ___Size: Diameter-------------------------°------------Depth---------- -----------------------------------------Liquid Capacity-----------------------------. gals. OPrivy: Distance from nearest well--------------------------------_ --____________Distance from nearest building------------------------------------------ I None Distance f nearest lot line____________________ _ } -------------------------------------------- �i Remodeling and/or repairing (describe): -------------------------------------- --------------------------- ------------ 1 I ------------------------------------------------------- I `1 hereby c rtify that I 11'e prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, St a laws, an les and regulations the San Joaquin Local Health District. ,. r �. [Si ----''------------- it ------ ----------_------------------- ----------------------------------- ---------------------------- __(Owner and/or Contractor) By=-- ---=--- ---- --- ----- Title Plot plan, showing size of to},I�I------------ - - -------------- --------------- --------------------------------- -- - [ p g ,Vocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY — if APPLICATION ACCEPTED B`Y-------------------j--- --- ------ --------�- --------------------------- DATE /---;�---------- REVIEWED BY 'll -- ----------, --------- -- - - ---------------------------- DATE' '-------------------------------- 1 BUILDING PERMIT ISSUED-- 1`------- - ----------- DATE---- ----------------------------------------------------- Alterationsand/or recommendations----------- ---------------------------------------------------------------------------------------------------------•-------------•-------------------•-------- q ------------------------------------------------------------------------------------------- -------------------------------------------------•---------------------------------------=------------- If -------------------------------------------- 'r __________.____________________________________________________________________ _ _____________________________________ FINAL INSPECTION BY: '' Date--- = ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT "130 South American Street 3oo West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100