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ROPPICk: Ubt: 3® <br /> ......... Permit No. . .......... ..... <br /> APPLICATION FOR SANITATION KRMIT <br /> - - ---- - ------------ <br /> leer. . _4� <br /> ................ .............. . ....... ------- I (Complete in Duplicate) Date Issued <br /> .. <br /> t This Permit Expires 1 Year From Date Issued <br /> .................. ------hereby made---- the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> See, Applicafion is to <br /> This application is made in compliance With County Ordinance No. 549. 6'- /OD-Zii' <br /> JOB ADDRESS AND LOCAT& <br /> ....... lZoolf <br /> tee, -�19,04 '1;--- <br /> Owner's Name ...AZAIV.-4C Phone..-.. <br /> ----­.. e 0pe ......................................... ................... <br /> Address._.._._........ ...134OX------19-40--a—-------Z'-W' <br /> &,, -,z, ......I............................... P <br /> Contractor's Name-----_........... ........... <br /> Iere Commercial 0 Trailer Court 0 Motel C] Other 0 <br /> installation will serve: Residence &'O"Apartment House El C . 0400de"_A-�— ----- - <br /> Number of living units: ...I--- Number of bedrooms - -1-Number of baths ../.... Lot size ...... <br /> Water Supply: (Public system C1 Community system 0 Private [!10"Depth to Water Table __... ft. <br /> Character of soil-4 a depth of 3 feet: Sand C3 Gravel [I Sandy Loam 0 Clay Loam [loor"Clay 0 Adobe [] Hardpan 0 <br /> -- ; <br /> Previous Application Made: (if Yes,�Iate--- ----------- ----I No W,-"Nw Construction: Yes E] No 3� FHA/VAYes E] No Cr-- <br /> ' I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:M? lot 200 feet.) <br /> (No septic tank or cesspool p± Itted if Public sewer is available with <br /> 01 all ....... <br /> Septic Tank: Distance from nearest well.-,:$V----..Distance from foundation---Av?.45; <br /> 'r -------- CaPacitY­ARd*'_0..(ZOA <br /> ze....Apk. ..-Liquid de -----%175"1 <br /> rV No. of compartments. >-----_--Si <br /> Disposal Field: Distance from nelarest well_,_4,V..�Distance from foundation.._?,5-_...0'_.DilItanc6 to nearest lot line_A:59? <br /> lines....-_.- 0----------Width of trench.___- <br /> Number of ines Length of each line.....Aa_- <br /> _-.0-sor......... ;------- <br /> Type of filter ma riaL 40 Dep.th of filter material..04.44!0Z:---Total length <br /> --p 40 <br /> Seepage�pit: Distance to nearest well..;e4oll..........Distance fSpm foundafion..,rA........Distance to nearest lot line.X.1.0F.P.---- <br /> Number of pits.------/...........Lining material. JV - -size: Diametsi---4 Depth. <br /> 9K + �� ef 7 <br /> Cesspool: Distance from nearest well..................Distance from foundation-----..............Lining material...................... ---------- e <br /> Cesspool: <br /> Size: Diameter.......---------------- -----------Depth__ -------w-------------------------...........-Liquid Capacity-_--_--------..........._g 01S <br /> Privy: Distance from nearest well.....--._................... ....._....----.....Distance from nearest building-----..-...__.-----_--------.__........... <br /> Distance to nee.rest lot line..... ................ ............. ................................................................. <br /> ❑ <br /> Remodeling and/or repairing Ides1lbe)%-------- -0�- -------S�A te-owr--------:............ <br /> it ....... ............................... ........................... .............................................................. <br /> ------------------1-------------------------------------- .....I........ ...........I.......... ------------- <br /> I <br /> ........................... ------- ------- ................­.................... ............................... <br /> ..................................................... .......................................... <br /> ......I­here-- b-y-1• __...__....._.._.---- ..-.:--.._........__....--... ...... .. <br /> certify that I have pr I epared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. State laws, and r regulations of the San Joaquin Local Health District. <br /> r <br /> (Signed)----------- ..... .... ..... ...........I........................ /or Contracforl <br /> By`------.._......--- ... ..... ...........................(Title...) ................ <br /> (Plot plan, showing Size of I-ocaiion of syste in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ..................... DATE_- - - ------ .............. <br /> APPLICATION ACCEPTED BY----- .... ........... ... ................ DATE_..._.-..................._....... ..- -.............. <br /> REVIEWED BY------ ...... ....................... ....- <br /> DATE......... .......................­­­..... <br /> I ........... ------ .......-------- ---------........... <br /> BUILDING PERMIT ISSUED..._--------------- ............... <br /> Alterations and/or recommendaticiini: �T ...... <br /> �..0........... ----------- <br /> 6 f........ A—& ..... ....... <br /> .............�Lm- ------- ................ ........ <br /> 3-1 <br /> ...... ..... ...... .......... <br /> e ... ........ <br /> . . .. ....... <br /> ... . . .. <br /> . ........................... .......... <br /> ----------- .. ....... ............ ........... ... <br /> FINAL INSPECTION BY: .. . ........ ---- Date_- ------ -----W---- ......................................... <br /> .... <br /> 40 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1001 a.narNlen Aw. 300 wart Oak Street 124 Sycamore Street 205 Well 911,Street <br /> L.di,California Manteca,C.10.1,,ic, <br />