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� r FOR OFFICE U`c APPLICATION FOR SANITATION PERMIT Permit 1• 1 t 1 (Ceepiete in Duplicate) __ 1 This permit Expires 1 Year From Date Issued Oats Issued ... �.. 4_t' Application is hereby mode to tie Sen Joaquin Local H,alth District for a permit to construct and install the work herein desersbad. TF;-, application is mode in c0rnp1innce with County Ordinance No. 549. JOB ADDRFSS AND LOCA,Tti .,... .,e10 .............. .. Owner's Nnmp !'Q ........ .......... . .... .. Phone................... Address........... .......... . __. /..'1;2C�;' ._ LAI. l../..T.h.......45*vsir'......................... .......... . ......................... Contractor's Name. . ..... 7'Axyl< 1 ..�G..�t/ Iti_................ .... .. .......................... Installation will serve: Rmider,:o r�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of li. . urits: / Numbe. of bedrooms ./L . Number c+f baths ...L.. Lot site�e.I.)N./.•3�iP................_._...._.. Water Supply: Public system f] Community system ❑ Private [ epth to Water Table(w ft, Character of soil to A depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay-Loam G}/Clay❑ Adobe❑ Hardpan:❑ ' Previous Application Made: !ly yos,date I No ❑ New Cdutruetion: Yes ❑ No [] FHA/VAt Yes❑ No❑ x TYPE OF INSTALLATION AND SPECIFICATICNS- (No septic tank or cesspool permitted if public sewer Is avali eWwithirl 200 feet,) Septic Tank: Distance from nearest wail.. .... ..... ...Distance from foundation...................Material............ ................................ . ❑ No. of compartments Size ................... ......—Liquid depth........._ ... .._.... Capacity....................« Dispo Field: Distance from nenrost well /047...:Distance from found n...J*4.!....Distanea to nearest lot li �,/.•�... j [ N,jmber of lines ... _. .../.,.... ,,.,........Length of each IineR...,�X.�.....V1/s f trench..../ � Type of filte- rrate+rial._r, s15000Depth -if filter materiel..Af.........._Tota gth_.... ..I....... ......... .�j Seepagrs PA: Oistence to nearest we; /.�)p. �....Distance f founde}Tori' '_...Dist a to nearest lo+line� t0....._ e 1 Number of pits _ininq mntarial,-«5 ��.Size: Diameter..;�r....Depth..... ,�.at_.._._......... Cesspool: D-s�nnce f,om r,Aarest well. .........Distance from foundation...................Lining material.................................. D Sao: Diameter ...................Depth..................._........ ....................Liquid Capacity......... ............. g cis. Privy: Distance {rom nearest well.....................................,...........Distance from nearest building..........._............................. ❑ Distance to nen.rst lot 1'.ie ...../.......... »............ ........._.......... ... ........._.......... ... _...... ......... Remodeling end/or repairing (dracr be) L�. /.... �. r�✓ �I�............._...... ..... ._......___._. _..._.._ ................ . . ........... .._ _....__...._................»..._..-._.-..._..---....._..---.-.------_--.------....-....-.-...-.-.--.-.--.......-.-_.._._--•--------........... -... .._ _...._.... __ _... _...._.... __.. _..__.....__... ... ...._................—_ .._._-------•--•---------------..-.-.-. _..�....-... _. _ _ _ ...-_.............._..-----.----.-.---.---_-....--..--.._.-----..----_..-......---------.....--.--------- z' I hereb certify that I have preperod this pReation and that the work wM be dorsi In accordance with Sen Joaquin County �r"• ordinances, SfiM lows, 4ad+ahn�end regulations of #6 Son Joaewin Local HealthD~ • c ttSS (signed)................... �•_" � a ......� "G ...... ............�/or C. onkaato ) er......` . ..... mt6)..... .. .... IPtot plan, s1#04ft size of lot, location system in relation to wept, build'srlgs, etas can be placed on reverse side). FOR DEPARTMENT USE ONLY 5 ','PLICATION ACCEPTED BY C. ;�. ........ ...`.?.it..1...........---...................... DATE...l��..j ..._.�`...� ........ � REVIEWEDBY ... .... __......_... .... ................................. DATE........................................................... f BUILDING PERMIT ISSUED .. ....�. ..... AMeretions end,or recommendations: _. y ....... . .. ................/..7.... ...c '. ...... ..... ...... ....................._...... ................................... .. ............................................ ....... ..._. ......... *... .. ,�. s........... .... .. .. - . .. .......................................................................................................................... FINAI_ INSPECTICrj BY: i 'ti ' '. .. . 7 - Date.. ✓ . ......:.-.�..6Y SAN JOAQUIN LOCAL HEALTH DISTRICT a 1601 t.Nasett,ea Avs. lee K'.st Oak Street 124 sycarnere street 305 West 9th$treet S#.Av",Callf.—I. lydl,Callfernia Manteca,callfernle Tracy,Cellrerrile t