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FOR OFFICE USE: // --------------------------------------------------- -----APPLICATION FOR SANITATION PERMIT Permit No...._L.�....-- �- (Complete in Duplicate) Date Issued ----- ------------- ___.-""----------'-------------------- ," This Permit Ex ires 1 Year From Date Issued C 9 G _,3 , f,o _ t 7 7'_ ------""`" ------ t uct and install the work hQcem d ri ed• Joaquin Local Health Distric Application is hereby made to the San t for a permit to cons r - J .4 This application is made in compliance with County Ordinance No. w 549. JV ' r ,1 s r. s _�------ JOB ADDRESS AN LOCATIONMA _ , :....... Phone o10ee, ----------------------------------------------------------------------- ----- Owner's Name-------- �p / .ntT_-.- -------------------------------------//---------------------- Address----------------�1• Q � 1 Phon lC-t�4i5_ �, --- Contractor's Name --r �'S "" Other ❑ Installation will serve: ,Residence Apartment House,❑ Commercial ❑ Trailer Court ❑ Motel ❑ J Lot size------ De XJf1P-------•---------- Number of living units: _1."_ Number of bedrooms Number of baths _1 F s Private ❑ Depth to Water Table /p" ft. Water Supply: Public `system Community system ❑ Clay Loam ❑ Clay ❑ Adobe C]Hardpan ❑ 4 Character of soil to a depth of 3 feet: :SandGravel C1 Sandy Loam ❑ Y FFiA/VA: Yes C],,-- No ❑ previous Application Made: (If yes,d'ate----------- _----- ___} No New Construction: Yes No•❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if. public sewer is available within 200 feet.) �i @ Distance from foundation.-_ _� MateriaN._____ Septic Tank: Distance. from nearest weil__/I�A�% --- -Ca acit �"""-- No. of compartments_.------------------Size__5----•--de� Liquid depth__._----------- P y'� _ "----____.._.Distance to nearest lot kin i1"�� Disposal Field: Distance from nearest well-_ .E.eSI--Distance. from foundation-/ �/ Len th of each Line_"'=--'�-5� Width of trench-.� -- p� Number of lines ---•- `- j g Total len th-----rl C'� •-------"."---- , Type of filter material__ --------Depth of filter material__r"--------- g Seepage Pit: Distance to nearest well__________ ___________Distance from foundation-__._ .___.._-.:.__.Distance t-- nearest lot-ine------------------ Seepage _.-__. __.__-.. ❑ Number of pits------------ ------- Lining material -----------------------Size: Diameter---- 171 ------•-----�---------Depth----�----�------••-------------- ing m cesspool: Distance from nearest well ----------------- _`Disfance:from foundation___.__=------- -----Lining Capacity gals. I; Depth----------=-------------------------- `----------- q p ty---------------------- . ❑ Size: Diameter--------------------- " _Distance from nearest building______________________._____._-..____.._ Privy: Distance from nearest well-----=--------- _ = ---------------------------- -- ----•-------•------------------------- ❑ Distance to nearest lot ine____s------------------- R ------------- . .....: Remodeling and/or repairing (describe):--------------' -------------------------------- =----•---•-------- -•---------...------- ---------------------- ----------------------------- ;---------------•------„ lIhereby certify that I have preapplication re htions Ili the San Johat.thLoc rHealthillleDi trCin accordance with San Joaquin County ordinaL. nces, State lt. aw ,and ules 9 f -. " wrier and/or Contractor] ----=�-� - - - --�..,�� --mac___ ----- ---- - ---------------------- - -- - c �.-------------- (Signed) 7" I tl By:------------- ----•---.----- - -- ----------- (plot plan, showing size of lot, location of system in relation to wells, buildings, can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE �- - APPLICATION ACCEPTED BY_ = , •----•--- t--,'�'" --- DATE_---------- _6 ----- -- �} a.. . REVIEWEDBY----- ------= -------- ----------------------------- BUILDING -- - - ------ BUILDING PERMIT ISSUED -- .. =_--• ----------=----------------------------------- Alterations and/or recommendations:._____-._----------------- ---------------- •----•------------------------- FINAL'INSPECTION 'BY:___.__----------- - ---�- ';-----•---- Date.- - �' = ----- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wast Oak Street 124 sycamore Street 205 West 9th Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodl, California Er -9 gEV,BEC 6.59 r.P.CP. ZM 6.613