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FOR OFFICE USE: ------ray Permit No. ..t_ -------------- _--"-" "______ APPLICATION FOR SANITATION PERMIT ------------------ �- \ 3-Le ------------------------------ -- ------ (Complete in Duplicate) Date Issued ------------------•---- _"_- This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND ATION..."___". ./-�-_-- t Owner s Name------------- ---- ---- -�- -- a----.. Phone-� !'"-f - .. Address---------------------------------------------------- -------------------------- ..-----�. c _- ------ --------A- -•-- ---------------.................................................... Contractor's Name------------------------------- a-&--•-----/- -----------------------------------•-----------•--- Phone--------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - - -----3� Number of living units; ----1._ Number of bedrooms"--- Number of baths ---I... Lot size ------- -----------------•------- "" l Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand ��am ❑ Clay Loam ❑ Clay ❑ Adobe 2/"Hardpan ❑ Previous Application Made: (if yes,date-----14--Q-------) No ©" New Construction: Yes 0o E] FHA/VA. Yes [-] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tek: Distance from nearest well "'��_".__Distance,from foundation---x a-___.--.""".Material"-G4" �- ------------- CY - -y ' � �"'� No. of compartments ----Size-----��---�K`�-Q. ------Liquid depth--------y �-�'------ Capacity-41 Field: Distance from nearest well---.--1---Distance from foundation--.gip--`------Distance to nearest lot line. Number of lines--_-----__� ---------Length of each line------- -------•---- Width of trench---�?-4-/-- ------------------- G` Type of filter material"_� r'/1�"��!Depth of filter material---/X------_-_.-Total length-_".. _.`s _ .......... -- Seepage it: Distance to nearest welt-" Number of pits-----c��.-_""--Lining material_}�C/- --Distance from founclation""t o__f---._-_.Distant a to nearest lot line�------------- \ !""_ _"---Size: Diameter----•��----.-"_"_--Depth_-------�-,�----------- ._...-- \ Cesspool: Distance from nearest well-=---------------Distance from foundation---.--------------- .Lining material"""_""""""-.""" ale. ElSize: Diameter------------------------- -----------Depth----------------------------- ----------------------Liquid Capacity----------------------------9 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.......................................... Distance to nearest lot line----------------- --------- ----------- - --------- - ----------- Remodeleng and/or repairing (describe):---_--------------------- ' -----------------------------------------------------------•-------------------------•-------------------------------•------------------------•--•------------------------ ----------------------------------- 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, an ru s and regulatio f the San Joa qqin Local Health f. (Signed) ---. -- (Owner and/or Contractor) 7,174:,70�- • ------ --- ": -----------------------------------(Title)---•- - &C ------- --------------(Piot plan, showing si= lot, location of system in relation to we s, buildings, etc., can be placed on reverse side) FOR DEPARTMENT USE ONLY i T ------------------- APPLICATION ACCEPTED BY--- --- ------------------------------------------------------------------- DATE--- r� -------- REVIEWED BY------------- ----------------------------- --------------------------------------------------- •-------------- --- ------ DATE--------------------•------------------•- -- BUILDING PERMIT ISSUED - --------------------- DATE-------------------------------------------- ---------------- Alterations and/or recommendations:-A----�1"-V- ----------0!+ �LI�`�s?-�'I�Q'�4-----------�� ----�� FINAL 5---------------------- ------------ Date--.- - ."-0 - -1--.-.--------- ----------------------------------- INSPECTION BY:.-."_C_r__-"�_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West oak Street 124 Sycamore Street, 205 West 9th Street i di,California Manteca,California Tracy,California Stockton,California Lo EE-9 REVISED 9.59 P.P.C9.SM 6.60 f�.r