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APPLICATION FOR SANITATION PERMIT Permit No. •: - - - - � . (Complete in Du`licate) Data 'sued r \ ` Application is hereby made to the Sen Joaouin Local Health Dis!rict or e per•nit I yZ ruct Snd inst Il,i#►o wor'hergN.A4 r bed <._ This application is made in compliance^with �QaT51,_ �Nld�5 1" ' /�- t �1�OW r IL— / V 1 ) a11 ► I JOB ADDRESS AND LOCATIO _.. r ' l SS �' r-F I. Phone �. Vsg Owner's Name.....�!5.1..1. ..�..�... ._�,:...... ....nn................. �-� A. .... ..... ... . .......... ........... ..... .... . 1 ..... .. Phone........... . Contractorm Contractors Naa....... :'.I.L.C.(L.z ,c Installation will serve: Residence [,, .1\vnrtmont Hot-so ❑ Commercial [j Trailer Court ❑ Motel ❑ Other ❑ "lumber of living units: . � Number of bedrooms . Number of baths ).... Lot size .. . Water Supply: Public system ❑ Com-nuni;y system ❑ Private N, Depth to Water Tablo'4-�. it. Character of soil to a depth of 3 fuer: Sanci❑ Gavel ❑ Sandy Loam❑ Cie LoamCey❑ Adobe /Hardpan G Previous A lir ation Made: Yes ❑ No [� Now Construction: Yes ❑ No [ FNp'C.' Yet F-� No�J Pr pp TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank or eess000l permitted if public sewer is available within 200 feet.) �Q . .Mat ��Ca�k1 Septic: Tank: Distance from nearest well � .Disten, lfrom fo gdotion. r U 2( tlo. of compartments. 21 . Size.. . .x F.A. . Liquid dev.th....... Capacity..... I th.......... Disposal Field: Distance from nearest weal � .Distance from founde}ioA.....I0.........Distance to nearest lot line. t Number of lines. ....t� Length of each line........�S.Cy.�.........Width of trench....ii. T. . Typo of filter matorinr.. � L .Depth of filter materiel....._ii . .... ....Total long1 O.. Seepage Pit: Distance to nearest well Distance from foundation....................Distance to nearest lot in ❑ Number of pits . .. Lining material.... . .. .. . . Size: Diameter,........... .. Depth Cesspool: Distance from nearest well........ Distance from foundation ........Lining material . gels ❑ Sizo: Diameter. Depth.. .....Liquid Capacity. . ff I Privy: Distance from nearest well .... ... . .Distance from ne-irest building. .-_...... r_1 ............. Distnnce to nearc•.t lot line -- •••••••• .................. Remodeling and/or repairing ;doscrib(,): ................................ .I...... ........ .................... ...................I .............. I ...... .......................................................... . .......................... .................................................................................................................................................... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I ($ignnd) it"L.L //L�// ( l' ( (Owner and/or Contractor) LN�.�i�� (Title By:.................... . P (Plo+ plan, showing size of lot, location of system in relation to wells, buildings, etc., tan be laced rn r_•versa side). -- --- _ -- - - FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY it DATE. . V ... .......................... �G GATE.... �. REVIEWED BY.. .. .. ..__... . _. �L, .............. .. . . , 4 BUILDING PERMIT ISSUED / ...... .. ... .._.. ... . DATE.... . .. Alterations and/cr recomr.rend-,?ions: . •• ••• ..,.......... ......................... .. ? CzKr .. . . ... .... . . . r•' Onto .. L '�"�• •� J FINAL INSPECTION BY: SAN J;OAQUIN LOCAL HEALTH DISTRICT .i 130 South American Street 3o0 West Oek Street 132 Sycamrre Street !11 North "e"Street Q S`ocitnn, Crrl:Inrn:e fedi, CnGlornia Manteca, California TneY• California I ES---9--2M Rrvsna t.57 f t'r