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FOR OFFICE USE; ----- ----- ---------------- APPLICATION -FOR SANITATION PERMIT Permit No, -------- ----- ---------------------- -------- (Complete in Duplicate) ------ - �. .,,.. Date issued �-�11�---"----� -- -------------- -------------------- - - ----- ------- --- This Permit Ex fres 1 Year From Date issued q f or p ins Application is hereby made to the San Joa um Local Health District fora ermit to construe and ®1„the�w°,l�ereies This.application is made in compliance with County Ordinance No. - 04 SOSTT I'� - -ADD - OF ..:. STI---- ' JOB ADDRESS AND LOC lON_____________ --- --- Phone Owner's Name---------- _ A.dS-r---------------------------- - Address Tom_.. 1= Q Z ---M I�IV� Cg_ -- ----------------------------------- ------ Phone ... •-------------- Contractor's Name- = Lff�" + Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence �Apartmen# House ❑ '�# AC�.��-�� Number of living units: -1----- Number of bedrooms _3--- Number of baths ___-____ Lot:size De th to Water�Table 14- ft. Water Supply: PuHic system ❑ Community.system ❑ Private ®— , p -- Character of soil +o a depth of 3 feet: Sand [Gravel El Sandy Loam ❑ Clay Loam ❑ Clay E3 Adobe❑ Hardpan [I ew Construction: Yes ❑ No FHA/VA: Yes E] No Previous Application Made: ;If yes,date___..----.:.------.1 No ® N - ®� TYPE,OF INSTALLATIONwAND SPECIFICATIONS- [N,o PECIFICATIONS:[No septic tank or cesspool permitted if public sewer is available within 200 feet.) -t M - Material---------------------------------------- Septic Tank: Distance from nearest we}I_________________Distan -------- -'- ce from foundation_---______-_ ..__ � Tf fJ 'r No. of compartments------ --------------- -Size-------------7 ---------- `.Liquid depth--------- Capacity Disposal Field: Distance from nearest well-- _--__Distance from foundation----I -__-___---Distance to nearest lot line.�S---- / Width of trench 2 Number of li.nes"'._:_______f__________________Length of each line_---- -_�Q- .. >r 4 Total fen th---------------1 ---------------- -C --------------- . 4-- A�D Type of filter matenal,_R4-�j'�-----Depth of filter matenaL_..1. - 9 af4 rte" v Seepage Pit: Distance to nearest'well_._.__-___._- Distance from foundation_ _.______ _ __ Distance to nearest lot line________________r �^ ❑ p Lining:material---------------------- Size-IDiameter7"- - ----Depth------------ ------------- ------ _ J Cesspool: Distance ofromsnearest wel!_______________-Distance from foundation-..._.--------:!t .Lining material-_._.____.__.- - i ---�� --De tli -S # -----------1-'-0--Liquid Capacity-- -------- ----------------gals., ❑ Size: Diameter----- -------------- - p1 I %-►�_"%j�1 Distance from(;nearest building-------------------------------------- ' Distance from nearest well-___------._- _.___ _ -- -- Privy: ' ' 3 ❑ ------- ------------- Distance to nearest lot line-----.-.--------------- - k ------------------------•------ TO Remodeling and/or repairing (describey______________- _ - _ _ - il: -- -------- --------- - ------ ------ ---- - ------------------------ --------------------------------- � .." -•----•--- --- ----------------- ---•----------------•------------------------ .. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County; ordinances, State laws, and rul ;and, regulation of the San Joaquin Local Health District. 4 ------------'-- -- --- ------------------- (Signed) - _ — . - rand/or C -- ---- - :. :._. -----------------. ---------------- ----------- on ------ -. - r �_ :. �, = , - Title] {Owne s- -— $Y 1 [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pace on reverse side). 1 FOR DEPARTMENT USE ONLY { . ,,. . ,�. ..� DATE-------- 3-�".��---`.��----- ----------------- -A_ --------- ---- ,- t-. 7 4 - -------------------------------------------- - -- APPLICATION ACCEPTED BY___---- --- ---------.R- ----- REVIEWED BY-------------------------------1----------- ---.-------------- ------- -�-�"�----- ------------------------------�,�--x.DATE------ -----------•----- -- ----------------------•------ BUILDING PERMIT ISSUED------------- ------- ---------------- ------ --------------------------------- -------------- Alterations ------------------ --- DATE Alterations and/or recommendations: TE --- _�' ----flP.r T----T�------+fes-5PEX'T~------40DV_F_RI--¢ 1 ,r °%� ---•----------•--- ------------------------------------•--------- 1X1=------41-K......45.-------SNQ AL-' ------ ---- ------ ---•------------------ --------------------- ------------------- Date------- ----------- -------7�r`. FINAL INSPEC ----- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 9th Street California Manteca, 1601 E.Haielton Ave. California Tracy,California Stockton,California Lodi, r.P.co.