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FOR OFFICE USE: '^ # ------------------ �6 , APPLICATION FOR SANITATION PERMIT Permit,No. _..1-�---a•• ••• ----- ----------- (Complete in Duplicate} Date issued ---------- --- ---------------- ---------------- ------- ; _ Thts Permit Ex fires 1 Year From Date Issued ---------------------- ---- , hereby made to the San Joaquin Local Health District 49 a permit to construct and instal4 the work ere�n described. I Application is i y ' 'w �% This application is made in compliance with County Ordinance No. 4 '40 625 vv ' ---- ------ --------------- 1 I JOB ADDRESS AND LOCATION ----- ---- ------ Phone-------------------------------- ------ -- ------------------ ----- -- Owner's Name l` �S " -��-add'�--------•--•-----•---------- t , J` ------ - --- -------- Address ------- ---- ---------- Other Contractor's Name.""------------- --- - Trailer Cour} ❑ Motel ❑ , [Apartment House ❑ Commerual ❑ a �_ Installation will serve: Residence Number of baths ---/__ Lot size ---"f 5 I Number of living units: ""/__ Number of bedrooms "r }h to Water Table /'r�ft• c Water Supply: Public system ❑ Community system ❑, Private;W Dep PP Y Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Y FHA/VAS Yes ❑ No ❑ Application Made: llf yes,date"-..--.-- 1 No New Construction: Yes No ❑ Previous App' P SPECIFICATIONS: IP (No septic tank or cess ool permitted if public sewer is available within 200 feet.) 0 TYPE OF INSTALLATION AND � , ce from foundation__3--o-------Material""P�-P---- -----------------�- -------""�"� Septic Tank: Distance from nearest Wella-------- DI�ZeaSy Liquid depth------- Capacity No. of compartments". .. ! C '�Q."-.""_-Distance to nearest lot line".____--."- Length of each line"- �._.-$Q-,$A�..Width of trench..--- --r - Distance from foundation"--"".-� 1 Dis osal Field; Distance from nearest wells--�.--- - - Number of lines__-------- I Type of filter material_Sl-�---- -Depth of filter materia l"".�-g---:--- ----Total length---------�--`f-------- ------ -----"-- Depth--------- ----------------------- k See age Pit: D'++stance to nearest well__"--_.____.______--Distance from foundation-------------.---".Distance to nearest lot fine".____.--------- 0 p -Linin material-----------------------Size: Diameter------4------ - j ❑ Number of pits----------------- -- g _ � Distance from nearest well-""-. at -""---- ----Distance from foundation.- Lining d Capac ty"------------------------•--gals. Cesspool: Ds th Liqui ❑ Size: Diameter- --------------------------- p i Distance from nearest building-.-.-."--"-_______ ........... Privy: Distance from nearest well--------------------- -------------------- f ❑ Distance to nearest lot line"---_.------------------ ------------- ------------ 9� -------------------------------- ----------------------------- � Remodeling and/or repairing (describe)---------------- ------ ------ ---- --------•---•-------------------------- ---------------•�----- ' ---------------------:-----•----------"---- ----•------------------------------------" t . .. -----------------------------------------------------4-'------------- I hereby certify that I have prepared this application San Joaqui hLocal Heall hep}�,4}n accordance with San Joaquin Coun y ordinances, M4, rules an regula �•.,_ , n,• ; -- _-__(Owner and/or Contractor) Si ned -------- - --- ------ ----- -- ---------- BY ------------------•---------------- - - - -rel-,.- -------- (Plot plan, showing size of lot, location of system in relation to wells uild'+ngs, etc., can be pace o reverse side). FOR DEPARTMENT USE ONLY --------- APPLICATION - DATE""�----_�=------y- --- --------------------- APPLICATION ACCEPTED 13 f- " --------- --------------- - ---------------- DATE- -- ------ DATE-------- - ---------------------------------------- REVIEWED ---- ------ � REVIEWED BY------------------------ - - ------ ------ ---- ----- - - ------ BUILDINGPERMIT ISSUED------------------------------------------------------ ----------------------- ---------------------- ------------------•-------------------------------------•---------- --------------------------------------- and/or recommendations:."-."-_._"-_.--.__-"-- - ""-.___----_-___-•- ,1 ---- ---------- ---------------------------- Date----fv— --( ------ ---- 1 ------ FINAL INSPECTION ----------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9t Tree 1601 f.Naxelton Ave. 300 West Oak Street C I Manteca,California Tracy,California Lodi,California Stockton,California