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FOR OFFICE USE: � /'� APPLICATION FOR SANITATION PERMIT Permit No. ........... ......... f ------------- --- --- ---- --- --- ---- - - ----- Date Issued �1---- . ------------------------------ ------------ --- (Complete in Duplicate) -- This Permit Ex ires 1 Year From Date Issue _ - --- '-�-" ""- ermit to construct and install the work herein described. Dis Application is eremadeadec Pl ante with Countyhe Son Joaquin a0 Ordinance No. 549.a p This application A- -A-47- - •----•----•-------.-- > _ r --- JOB ADDRESS AND LOCATlO Q ------ Phoneear..- ; fes Owner's Name_ --•-•------- --------•------------------ ��' �.717)rp- ------ Address----------•------------•---F�---..__ Y--•----- .................• Phone_.._..-.--"---- . ------------- Other ❑ Contractor's Name---------------------•----L7'� �` --------- ---- Trai er Court ❑ Motel ❑ / A artment House ❑ Commercial ❑ I l Installation will serve: Residence P Lo} size -_.------ �--' / Number of baths 1,4 -1 I Number of living units. _--t"-" Number of bedrooms __ Depth to Water Table .,-_--- ft. Community system ❑ Private ❑ Adobe❑ Hardpan ❑ Water Supply:- Public system 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Character of soil to a depth of 3 feet: Sand New Construction: Yes No ❑ FHA/VA: Yes ❑ No ' Previous Application Made: (if yes,date--------------------) No TYPE OF INSTALLATION AND SPECIFICATIONS: a JF f" / (No septic tank or cesspool permitted if public sewer is available within tad f #f1n�Mafieriai _T�------Gt-------- -- Distance from nearest'well_�� --Dis#anc� �fprom�founc�tioa_ _-- -- f Capacityd r Septic Tank: Size-.` x ..Liquid depth I No. of compartments------o'-� (` " .._Distance from foundation-�4' 04,, Distance to nearest lot lin _-'a-_ �'I!` Dispose Field:' Distance from nearest we! _.--_ -----Width of trench------ - -•� ------ L.. Len th of each line---------- 7 g' Number of lines---------------- --- g 11 [� ----------Total length---------1_��--a----•- Type of filter material-5erC' Depth of filter mate Distance to nearest lot line----------------- Distance to nearest .well---------__--_--_----Distance from foundation--------------- Seepage Pit: Linin material---------- ------------Size: Diameter-----------------------.Depth----------------------•----- ❑ Number of pits-------------------- g Cesspool: Distance from nearest well-----------------DDista hce from foundation-----.--_---_------Liquid Ca material ----------. gals. ❑ Size: Diameter------------------------ P - Distance from'nearest building--------------------------------------"-- -� Distance from nearest well---------------------------------------------- -------- --------- Privy: _ --------------------- - ------------------------- ❑ Distance to nearest lot ine-------------------------- - Remodeling and/or repairing (describe):------------------ ---------------- _ ------------------------------- -------------- -------------- _. ,.a_, ----------------------------------------------- - ---------------------------•------• ---"-- ---------------•-----------------"-- h • - - -o --------------------- -- ui I hereby certify that I have preparedthis application the Sand that paqu.the work Local will be don in accordance with San Joaquin oun y ordinances, State laws, and r !es and reg i --------------------------------------------------------- -------(Owner and/or Contractor (Signed)_ X.- ------- ------------- ----- - ------- -------------- (Title) BY: (Plot.plan. showing size of lot, location.of system in.relation to wells,Ybuildings, etc., can be.placed on reverse side).... u FOR DEPARTMENT USE ONLY --- DATE._._------- - - --- - -- ------- ---------- -- -------------- -- - - APPLICATION ACCEPTED B _----------- ----------------------------------------- --------------- - - -----------• DATE------------------------------------------------------------ --------------- ----- ------- REVIEWED BY----- ------ ----- -----•---- -. DATE -- -------------------------•-- BUILDING PERMIT ISSUED-----------------------------------------------------------•--------------- •------ Alterations and/or recommendations:------------------------------.-------------- ------------------- --------------- -__..--"--•------------------------;-------------------------_------------..- -----------------•_------"--•------- Date--------- - � � I FINAL INSPECTION BY:-._.--_--------- - --- -- " -- SAN JOAQUIN LOCAL HEALTH DISTRICT st Oak Street 00 Well e 124 sycamore Street 205 west 9th Street 130 South American Street Manteca,California Bracy,California Stockton,confornia Lodi,California E13-9 RKVISEP 8.59 F.p.CC,1M 9•913