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y.. ;x FOR OFFICE USE: 4 ......... . .._. .. ..............I........ _ Permit No. .,g./,7 APPLICATION FOR-SANITATION PERMIT _ . (Complste•in Dupticate) Date Issued tl ..... This Permit Expires 1 Year From Data Issuad Y Application is hereby made to the San Joaquin Local Health District for a Permit to construct and install the work heroin descn'bed. This aFplication is made in compliance with County Ordinance No. S49. �$CALON ,, �. t 3 y O n ,�F..._U<<...dR�,Y.R ._... .._._.._... JOB ADDRESS AND LOCATIO .S•1A._EI. .�RL. ..M..r�...,/.•-•-.•--•-•- Jwner's Name._ ....... .. f�1. 0.1�..r.. - .........._....... .................._...... Phor+e__�__ _.». . 0/%Klf2�-t .......... __.._ ....._ __ ... . Address.. ._.l71.. -_ ..._... n. ..._....�. .2i— Contractor's Name... wt�!••��•--• Phone._ Installation will serve: Residence (YIApartment i louse C] Commercial C] Trailer Cour+ ❑ Motel [j Other ❑ Numbs• of living units: Number of bedrooms..LNumber of baths .1...... Lot size Water Supply: Public system ❑ Community system �rivata ❑ Depth to Water Table. -Sft Character of soil to a depth of 3 feet Send ❑ Gravel ❑ Sandy Loam❑ Clay Loam Clay❑ Adobe❑ Hardpan No Previous Application Made: (If yes,date..... . ._....... I No,�New Construction: Yes ❑ No FHA/VA:Yes❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: -- sr.rs (No septic lank or cesspool permitted if public sewer is available within 200 feet.) . Septic Tank: Distance from nearest well.................Distance from foundation...........-......Material..........-......_._..._------------.- ` F �- d pa ty._......_. »_» EyX!}T7NC- No. of comport,Hants........................Size..._..............._....._—Liquid depth........_........... . Ce c, ..........Distance to nearest lot line.-S—. n'-.• Disposal Field: Distence from nearest well..7�.......Distance from found etion...f._.. !c • : 15�5T1 A!�'r g .......�.....v/idth of french........ Number of lines...._....�...............••.••••Lon th of each line.._.... :.r. Total len th..-•--_- ---- ,., Type of f4ter materialj1OG> -....Depth of filter material.... g - — r}7 .-� Seepage / Pit: Distance to nearest well..... P.n.......Distance from foundation._�Q_._."_p,stee to nearest lot line_._�r-- . .. '•.`�-, IA�7. Number of p,ts.....(..._......._.Lining material..RQCK.....Size: Diameter_7. -X_ ..... Depth_..._..�`1—..•.•-•••-- - 3 Cesspool: Distance from naerest well................Distance from foundation...................Lining i.,eterial.........__......._. Zt: ❑ Size: Diameter. .......................Depth..................._.... .. ....._...........Liquid Capacity... ...._......_.....__9als. r :.r.;:y . pry„y; Dis+once from nearest well................................................Distance from nearest buildin _........_.._...__..._........_.-.-._..........._.............._._._ r •,`�;._ ❑ Distance to reerest lot line............................:......._........_......... • Remodeling end/or repairing (describe):................. ....._- _......__�.._._ s _.. ................... �T� .. ..... ... _ Health ............... _....._.....�. _.. ._......._.._._............................................ ....._ __-............... . _ ... .... .... ..... d that hwill be accordance Awith -�San . J.o..aquin-.�--..m_._y Ihb..certify that I have prepared this ael ication an ordinances. ate ws, es regulationsf the Sen Joaquin Distrt .. 3 _..............__................................................... r an c (Signedl- ..----... , (Owns and/or Contractor) - -----------------.................. itlst._....... --.._... By:___.. ._..._... _ _....._..:_...._...... . ... (Plot plan,showing sae of lot, location of system in relation t r ells, buildings, eta, can be placed on reverse side} i-0R D RTMENT USE ONLY T. /V-1a a.. _.......... DATE...... . w. .. .r._...» .._»..... APPLICATION ACCEPTED BY_....T..r..R._....._-•-..................._._......._. - DATE.................._._.._ s. REVIEWED BY.................... ._ _..._..__............_...._........ . _... DA _...--.._. BUILDING PERMIT ISSUED.:_......__.- __.�........................ _ »- R .SAnfQ....?ttAT...... �z!�__..liti44 - Alterations and/or rowmmendations:._...�.LM. _ c..�........---F�_tz,.......Et n(A.c�..._...L�tYs Pc7.�onl.-......SyS.......7�,rJ9 �D...._f .._._5�1L�.�Nn,:--• -- __._lVC1.._...- N. C. .....��S.Cf-(.f1Rl��................_................................... __.._... _... - ............. • :..- ... i Date......._....... _ -J D.". FINAL INSF' - SAN JOAQU!N LOCAL HEALTH DISTRICT - r l a01 s Isasolran Ave. ::..ar 124 sycamore treat 20S wast 9th Street t goo w.rt a1, e yocaw..,Callfernia ledl California Manteca,California Tracy,California E.N.V 2Mt 1.67 Varq and Fms l Fl w