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33 MIT Permit No. FOR SANITATION PER APPLICATION / �. (Complete in Duplicate) Date Issued .�-_117#-r� r Health District for a permit to construct and install the work herein describtsd. Applica+ion is hereby made to the San Joaquin Local This application is made in compliance with County Ordinance No. 549, f ..3 C3 r4 Qt) i�i i4✓ �_ ,� •"" --------- JOB ADDRESS AND LO ATION.+__ '-- -f 7i 7 Owner's Name_________-_ _r Phone. Address ._.._..L= - --•---------------------- / =------------------••-- ------------- Phone. G--^------ Contractor's Name-------------------------------- ----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I_-_ Number of bedrooms ----- Number of baths _j--- Lot size __��l3_�_--, _�.-R------•--------------- ? t. Water Supply: Public system ❑ Community system ❑ Private [Depth to WaLoam ter Table ❑ Clayf❑ Adobe�ardpan F]Character of soil to a'depth of 3 feet: Sand.❑ Gravel F1Sandy Loam Ely Previous Application Made: Yes ❑F No � New Construction: Yes [No El OF INSTALLATION AND SPECIFICATIONS: (No septic tank or.cesspool permitted if public sewer is available within 200 feet.) 0 - Li uid depth -------' Capacity--�A'�-- Septic Tank: Distance from nearest well_:�----------Distance from foundation__"________"._._ .j , No. of compartments-, -----------Size `T------(_-0.,-- q i p , , Disposal Field: Distance from nearest well--.3_rd__:-.-Distance from foundation �-----Distance to nearest lot line__.____.S-• } Number of lines----" --.•- --------------------Length of each line------- - --��-- Width of trench----- -• ---------------- Type of filter mater---- !_e-o _._Depth of filter material_____,f__--..---_Total length_____-_7 ---------------------- _ Distance rom f undation__. a_.�_.__.Dista��e to nearest lot line__`--_--------- Seepag it: Distance to near well_._�_d-l�---=-- Size: Diameter__-- 3-----------.Depth._.4R--7------- b Number of pits----_.1-------------Lining material_t-_ _-.-_----- ---y t Cesspool: Distance from nearest well------.----------Distance from foundation---.--------------. Lining materia!____.._______.________-____.----•---• Liquid Capacity gals. ❑ Size: Diameter------.------=------------------------ a -------------Distance from nearesf building?--__ ____--____-_ Distance .from .nearest well--------- - 1 Privy:. I � 4.. - � -------------- --------- -------- -- ❑ - -------------------------------- --� - Distance to nearest lot line------------------------ d i k ------------ Remodeling and/or repairing (describe):_. ----------------------- ----------------- ----------- ---------•-- ---- -----------— �. --------------------- + ------------------ ________ _ F - -------- ---------•-------•--------------•-------------•------ I hereby hereby certif that I have prepared this application and that the work-will be done in accordance with San .Joaquin County ordinances, Sta law , and rules and r ulations of the San Joaquin Local Health District. l ----------------------- ----- - er and/or Contractor) -- -(Own d/o or] ---- ---------- --------------------------------------------- (Signed)} --------------- (Title) Sy:. (plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- --- ----------------------------------------------------------- DATE / . g _ �----------- DATE- ------------------------------------•---------•---------- REVIEWED BY----- --------------------------------- ----------- - ---- -- ---�--- --------- DATE-- ----------------•-------------------- ------------------- BUILDING PERMIT ISSUED------------•_-------------• - --- ------------------------- ---------------- --- ------------ Alterations and/or recommendations:---- ------------ -------------------•--------------------------------•------------------- ------ ------------- --------- ------ . . Date-------/ r ------- - -------------------------------•---- FINAL INSPECTION BY:.. ---- -- --� ------------------- - " SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street ,130 South-American Street Manteca, California Tracy, California - Lodi, California S}oc7;ton, California j.E_ 2M 145446 PTWO9 D� .,1Z }