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+ FOR OFFICE USE: r ------------------------ -- ------__�_ APPLICATION FOR SANITATION PERMIT Permit Na. •---5- J F (Complete in Duplicate) Date issued __Y- -7_.�_._� ------ This Permit 1`x fires 1 Year From Date Issue ------------------------------ ----------- A is hereby made to the San Jaaqu;n Local Health, nceDlNoG 549 a permit #o construct and install the work herein described. Thisapplication is made in compliance with County Ordinance z- =7 --------- --------- ------------. � ' JOB ADDRESS AND LOCATION---__-•- -- Phone---- ._.� --•- - Owner's Name----=__1-� ------•- ; ---------------- ------------------------------------------------ Phone._ G-• 5!`3r�.�_ ,, Address__.._.-`2!_.2- .•• . MIA------------ Contraetor's Name----------- ---------••--- -` ` ^ TraileraCourt#•OMMo}1.0•-Other-0 "`� ii A artmenf House ❑ Commercial ❑. , Installation will serve: Residence 0' p �Q__�-.-/--AQ------------------------- i �_'. '►� : :.�"`Number of baths __ __-_ Lot size ____-- �--t-Number of'living'uriits:"'f:�"`Number of bedrooms - D� }h to Water Table 3'�-_ ft. �lPublic s stem ❑ Comrnuriity system ❑ Private p ❑ Hardpan ❑ WaterSupply: Y ❑ Clay ❑ Character of soil to a depth of 3 feet: Sand e' Gravel ❑ Sandy Loarn❑ Clay Loam FHA/VA-e No ❑ i i New Construction: Yes a No ❑ Yes ❑ Previous Application Made: (lf yes,date------------- -- - -) No [�� TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sew.eFr is available within 200 feet.) Distance from nearest well_________________Dlizseance from fouhdation____._..__._______-.Material------------------------------- Septic T k -----I---:---Liquid depfih------------------------ Capacity_.. ' n No. of compartments-------------------------- e o v Width of trench ' - D�"e"I Field: Distance from nearest well __f-b-.-----Distance from fou da#ion___-/. _. - __.Distance to nearest lot�ine_________________ © Number of lines 1 -----------Length of each li a oe n y _ Depth of(filter mafierial___ -8- --- ---Total length________________ \ t Type of filte_rmaterial____ - -- r 1 See age,Pit: Distance to nearest well--_________________-Distan�.e from foundation____-___.__•__._---.Distance to nearest lot line._._.__.___.---•- p t F --Size: Diameter--- ---------------- ---Depth--------- ❑ Number of pits----------------------Lining ma`terial__-___-�-------4 als. Cesspo:l:' Distance from nearest well-----------------Depth Distance foundation Capacity ------------------------ _Lining ❑ Size.j Diameter-------------------------------------- ---- t I - _ --Distance from nearest building------------------------------------------ -------•------•------------------ , Privy: Distance from nearest well---------------------------- --- i ------- + Distance to.nearest lot line-------------------------- 4 ; ❑ "%;t --------- l L Remodeling and/or repairing (describe:---- +M+w•�+ _1---------------------------------------------•----------- '.-•-----•----------------------•- i ------•----------- -- ---------------------------- f•--•--.-----------------•----------------------• - ,, . -- -----------------------------k ._--_______----__._ -p__._______ n- land that the work will be done in accordance with San Joaquin County re orad this a plication, x I hereby certify that I have p p ordinances, State laws, and rules and regulations fof the San Joaquin Local Health District. (Owner and/or Contractor] 1 ----------------------------------------------- g 1 f �' - Si ned $Y= v -- - -- t - - ------------------- ---------- ---------- V (Tit e t=== Plot plan, showing size 01�lot, location of�system-in,relation to wells, buildings, etc., can be placed on reverse side). s ( it FOR DEPARTMENT USE ONLY 1 '~ ----•- DATE_. APPLICATION ACCEPTED BY ------------ DATE------------------------------------- REVIEWED BY---------------- ----------- -- ------------- BUILDING ns and/or rISSUE endations: - - M1 •--•--------------------- Alt ecom ----------------------------------- -------------------I ---- --•--•------- --•------------•------•--•------ r -------------- --------------- ---- Date-------------- FINAL INSPECTION BY------------ - - --- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT + 124 sycamore Street 20s West 91h Street 130 South American!5tre 300 West Oak Street Manteca,California Tracy,California I et Stockton,California Lodi,California ss-s 9EvI6Co 6.59 F,P.Gfl,$M 6-60 ' ,s