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FOR OFFICE USE: - _ APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------_-------------------_ �y �it �11//2 �r (Complete in Duplicate) Date Issued --------------------k- This Permit Ex ires 1 Year From Date Issued /� Application is'hereby;made to the San Joaquin Local Healfh!District for a permit to construct and install g work�h�r�i� descrbed. i This application is made in compliance.with County Ordinance No. 549. C,y-Y ati/` GL / (S � - �'w ria s'J�J _ I ..�� (/- �- --------------------- JOB ADDRESS AND LOCATIO�.4�: �--• .� ' Owner's Name ------------- ---- ----- -- ---- -------- ---Rl� Address --------•--------- -• { Commercial'[] Trailer Court Mot one I Contractor's Name---------------------- ` t ❑ ❑ Other ❑:N i Installation will serve: Residence �r Atpartment 1-louse ❑ tom � QA D „Fad ,t Number of living units: __�___ Number of be _�_'4Number of baths _�-___ Lot size __�_�..___-- - --.�-----�•--------------------------- i -----__---- - ; t.�+..� ''llf�#t Cornmunit s s ❑ _Privatet5T Depth to Water Teble Water Supply: Public system ❑ Y Y " Clay Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ®/ Gravel-❑ LSand Loam ni G.. ❑ y ❑ 0 Previous Application Made: (If yes,date_..--..--•----------I No New Construction: Yes 10 [I FHA/VA:: Yes ❑ Na ❑ r : TYPE OF INSTALLATION AND 5PECIFICATIONS: ► _ -w--' ~ t. - -... ' No.se tic Tank or cesspool permiff,drif--ublic-seW,or-ls available'=within 200`'fee-f- ( P P ' - t 1P .10 Septic Tank: Distance from nearest well_._5__A_-_____Distance from f.oun Ation-__�--------------Mate is___-____.____--------------- o_ _ Size _ _ _---Ca Capacity--AZO-4 i No. of compartments------�............._ - �' Liquid depth------- -- ---------- P Y __---_Distance from foundation. _a "r^'-±r'Distance to nearest lot line___.'1_------V- . Disposal Field: Distance from nearest well- 6 v �-.____.Width of.trench.s� �i--`�©--•---- __,Len th of each line_--_ 9- re 1 Number of fines = -� �a9 ,.� �-`e s� Total length -- = ;:---------•---- De th of filter rnaterial____f_ -_- -------- �} Type of filter matedaL__sSt__Y---------- P - 1 r �^ �.z Seepage Pit: Distance to nearest well-____--___..'.______-_Distance from foundation____________________Distance fio nearest lot'ne___.___-_-------- �- _ Depth--. '1N ' Number of pits- ---- ------------ -Lining material--<,-------------- - -Size: Diamefier------------- ---- ) ❑ r Cesspool: Distance from nearest well_________________�etthce from foundation_-_--- ---------Liquid Capacity_..-------------------.-----gals. A Size: Diameter--------- :------------------ P 4 ❑ • - ----------------------------------- Distance ----------- - ------- --------- ' Distance' from nearest wall----=--------------------------------=`-------- a i Privy: _ -_ � ` Dia#ante from nearest building a ❑ Distance to nearest lot!line-'-- Y - ------------------------------•------------------------ .----•'----•-----•-------------------•--------------•---•-----•-------- Remodeling and/or repairing (describe)-------- -•- --------•-------------------------------------------------- --------- �----- - --------------------------------------------- ------- •------ --------------------------------------------------- . ... V -'-------•-------------•---------------------•-----------•--- } ---------------------------- -------------------------------y----------—-- -------•--------•__..•---•--•----------- y, -'•-f e;' - will --- ------------------------------------------ I hereby rtif -that'I Have prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, t #e ws, and rules and regulations of the San Joaquin Local Health District. --------------------- _ -. (Ownern orContractor) (Signed) - -- _------- -------- ---- iB ------------------ ------,---- ----------------- ) (plottan, showing.size of lot, ocat�on;of sys+t rn in.rely+ton to P wells..buildings. etc., can be placed on re_verse side). i F R TMIENff Si ONLY xATE f^ ------------------- B APPLICATION ACCEPTED BY---- R ----------- CA-------- ---- --------- 0& ------ - ---- DATE _ _ -------------------------- -------_---- mss-=-------------- REVIEWED BY = BUILDING PERMIT ISSUED_.. - - r�.�_1_-�-----------------�-----=------------------• DATE..---------••-- - Alterations and/or recommendations:--�q FZ�--- �D� p 1 15___�r-.._�> S.I'4--•- --_-----••-----------• 11----•-------------------------• . ------- --------��-�---'r--- �' [. ----- �_ ' (_.------- -5---- ---- �P't`�4F_�._�__. .,r��.�rcvl--------------------------- - - - �--:-:.-Date-------- 777-;V-41 -------- FINAL INSPECTI BY:-"_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 south American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Locil,callfornia Manteca,California Tracy,California - ES-9 REVISED B-59 F.F.CO.2M 6-60 r -