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FOR OFFICE USE: I Permit No. ............-.:--- --------------------------------- APPLICATION FOR SANITATION PERMIT ..---....V..................................... (Complete, in Duplicate) Date issued —14 - 7 ------------------ ......... .... . . .. ........ This Permit Expires 1 Year From Date Issued 'it to cons ruct BT ri to cons n .install 11 the work herein described. Applicaiion is hereby made to the San Joaquin Local Health District for a part This application is made in compliance with//County Ordinance No. 549. - 44 A LOCATION-St..... --------- ---- ------------------- JOB ADDRESS V............ phone.............. .................... -40-1000I.A.4-tad............. ----- Owner's Na Me ------ ........ ............................ .... .. ...... ---------------- ------------------- ------------------- Address------- ...... Phone------....e Contractor's Name........64,vt�-; --- ------- ----- --- . . ........... ......-----I....................-_.. Motel [] Othr installation will serve: Residence El j Apartment House ❑ Commercial [] Trailer Court 0 baths --1... Lot size ...eld-17-01114-11f--Q------------ --- Number of living units; 7!77!. Number of bedrooms'`. Number ba fh Community system 0,t k Private [�Dep to Wafer Table - ft" Water Supply: Public system El � Jay 0 Adobe 0 Hardpan O. a*: Clay Loam �C' Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam C1 I No E] Now Construction; Yes C] No E] FHA/VA: Yes 0 No 0 Previous Application Made: (if yes,clote....... .. ........ �1 TYPE OF INSTALLATION AND SPECIFICATIONS: l pi�rmiffed if public sewer is available within 200 feet.) (No septic tank or cesspool IP .. ...MateriaI--- -----Distance Srom foundation..../.. ....... Septic if I /...........Capacity--- --- ---- Distance from nearest well.._.> D..._-. clepth—----IA.- No. of compartments-------o�t--- ----------sizeX.P.7—A-S-f—Liquid tion—AL7.1......Distance to nearest lot line........ Disp field: Distance from nearest well.... ......Distance from founda ... P.k- I IOS /111 $ I -Y--W Width of trench.... .---------------I--------- Number of lines -- -----------------------Length of each line-..._.. RA ........... -------- Type of filter M ....%&-o --Depth of filter material---- ------Total length... See t: Distance to nearestI well clation -d.jo-t......Distance to nearest lot line... ------- .....1-049.....�Distante from un P ............... Diameter-,? ---------- Depfh.,M*X P/8P I Number of pitsj......I...........Lining male. )�c Size: '" Cesspool: Distance from nearest well. Distance from foundation ...........Lining material.--------.................gals. ❑ Size: Diameter)..-......------ . ------ ------.-Depth-------------------------------------- ---Depth----------------------------- -7- --------Liquid Capacity.......................... Distance fnearest earest well ---- ---------- -- .. ............ ........Distance from nearest building...-_.--------------------------------- Privy: Distance to neat 0 est lot line........-------------------------------------------------------------------------- .................................... ....................................................................----------------------------------------- -----------------------------...... Remodeling and/or repairing (desciibe)% ------------I........................... ........... .......................—---—----------------— ........................:........... ....................................I......... ................................... -------- --------------- ........................................................... ...... - ------------- .... .................................................. ------------------- -----------—tic.n-and..that..t-h.a..war-k--will--be--done in a ccor d a n c a wish it Sa n Joaquin County I hereby certify that I have p�rlepared this application al Health District. ordinances. State laws, and rules a.nd regulations of the San Joaquin Loc I - ......... r and/or Contractor) .................................. (Signed)-- ----- .................................................. BY:--------- ...... owi plside . ... ... ....A...... ---- ------------............ Irt"911..... elation f wells, buildings, etc., can be placed on reversesi I (Plot plan, Showing size of lot, location of system in r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...... --. _..-.. .......................... REVIEWEDBY----------------------- -------------------- - ....-------------------------- ----------------- ................. DATE----------------------- ----------•-.....--•----------- ----- ------------ ----------------- ..................... .. - - .'. ... ................. ... .........-..........-............ ..-.--...-...-....-..-........-...-...-..........-..-...-..-....-....................................................I........D.........A...—...T.....E...—.............................................................................................. ....-.-..-..-.--.-.-..-...-....................................... .............. BUILDING PERMIT ISSUED - - . ........................-...... ----- -- ............. ..................... Ateraions and/or econmenca+iA ...............................................- t ... ........ .................. ................................... .......-... .. .......—..... ......... I. ................. ............... ........ ... ... . ..-1-1-.---.......... . . .................... ..... . . .................. ................ ..........----- -------------- ---- ---------- .................... .................... ............. .... .. ...... .. ... .... ... ... 12 INSPECTION BY:.... Date.A? ................................................ FINAL SAN JOAQUIN LOCAL HEALTH DISTRICT 205 West 9th Street 1e01 E. Mox.lt*.A�*. 300 West Oak Street 124 Symm.re Street CaliforniaManteca,Celbernia 1,acy, California Stackta, California