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FOR OFFICE USE: t , ------------------ --- ----------- ------ - " APPLICATION FOR SANITATION PERMIT Permit No. ... - -------------- - --- -- --------------- ------ ( P 6 l�_S- Com (Complete in Duplicate) Date Issued .___.- k_--•-- This Permit Ex 'iyes-1 Year From Date ,Issued------------ ,F Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work.herein described. PP 'County Ordinance No.. 549. This application is made in compliance with, G®- -S 174-19 ,. JOB ADDRESS-AND LOCATIONS---=---- --------- - Phone-----•------------------ ------ Owner's Name--------------- �- --• Q>1�_��--�-� '----------------- - --- - - ----- --- ----- - - - _ •----•--.. 5 � -A-�=�---------------------- ------------------------------ Address ._ X.------------------ �7 ,�g ------------- Phone--------•-- - -------------------------------------------- -- CJgfV_ Contractor's Name______•"_..___ , Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other l 7 _ " Number of living units: __i Number of bedrooms 3__ Number of baths _1----- Lot size ---So---- Communit s stem ❑ Private ❑. Dep Rh to Wafer Table -- _ ft. Water Supply: Public system Y , Y Adobe ❑ Hardpan ❑ Character of'soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [t1C4ay Loam ❑ Clay ❑ Construction,: Yes �"'�No ❑ FHA/VA: Yes ❑ No [�'� Previous Application Made: (If yes,date_.._-.------- New Co 7YPETOF-INSTALL-ATION.-ANDrS.P,EC)FICASIONS ,Ik "*(No,septic tank or cesspool.permitted if public sewer is available within 200 feet.) Material----R VV Distance from foundation___ Septic nk- Distance from nearest well C1,__VV__ Capacity �J- �a - -----Size_��-�_9._�-�-�-------Liquid depth--.cf��---------- P Y•-- � No. of compartments_..-._. .- y-� Field: Distance from-nearest wel ----- LI Distance from foundation__ ----------Distance to nearest lot line_,��•--- Number of lines--,_.__3-"=-;�.�..;:x. - --.---Length of each line��-'-��.d._�,�Widt4� of #rencll---------'�-.-- -.=---�--------------- Disposal i .�j Total length------ --f ys�=--------------•--- Type of filter material__ll l _l _"- -Depth of filter mat ------------- Seepage Pit: Distance to nearest wepj:=": _____-____...,__Distance from foundation Diameter_ ---stance to nearest lot line----------------- Seepage .---.-_----_ Number of pits------------F __._Lining maferial__ I ❑ ------ --------- --------- Cesspool: Distance from nearest,;well ---------------De�ahce from foundation-.-- -- _Liquid Capacity------------..__-.----------gals. ❑ Size: Diameter R Distance from nearest building-------------------------------- Privy: from nearest well'_._--------------------------- --------- 1 Privy: - --------------------------- ----------------- Distance --- --- ------ ❑ ----------------------- - ----------------- ---- Distance to nearest lot line__.__._-____"__-" Remodeling and/or repairing (describe):____-----__�/-� Q i ,.�,._ ---.-.::---- ------------------------- r,. 11V ' i - L -------------------------------------:----,--- -- are --- f I hereby certify that I have prep d..this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. A --------------------------- ------------------------------------ (Signed) and/or —Contractor) - - - . ------ ---�1------- - - ------ ------------- -- - weer 1 — --------------------- (5tgned) - _. ,.. ., .��- - ----.-'-`Title)'. �., --- - ---------------------------------------1i------- ----------------------- (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 _ - t ''------------------------r' DATE_..---- �S, ----- ---------- -- ------------------ APPLICATION ACCEPTED BY------- 1. - '- -------•---------------- _ � ------=--)F1----------- DATE----- ----------------------------------- REVIEWED --- ------ -------- - REVIEWED BY--------------------------------- - ac -- BUILDING PERMIT ISSUED---------------------------------- ------- ---------------------- ----- - -- ~ rt�� ea -------------- Alterations and/or recommendations:----- �� _` µ-: 'Jr'7 T- -------•--•------- -- ------ - r ----------- -•---- -------------------- --------•----------------- ---------------------------------- ----- -------------- -------- -------- - ---- ---- ,r'Of� Q� I1 ►�'---`---------------- k _____------------__ ... ------------------------------------------------------ --- --- --- .... --_.-- ff Date--------IR— .......6—S ------------------------- FINAL INSPEC B -'� SAN JOAQUIN LOCAL HEALTH DISTRICT r. .124 Sycamore Street 205 West 9th Street 1601 E.Hazelton Av*. 300 west Oak Street . Manteca,California Tracy,California California Stockton,California Lodi, �- F.P.CO.