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FOR OFFICE USE: 6 tvi- APPLI Permit........... CATION -FOR SANITATION PERMIT Pe No. ..,L ......... .......... {Complete in Duplicate) Date Issued ........................ This Permit Expires 1 Year From Date Issued 102--too-,02— Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND�LOC 710N. ........... .,.. ... Owner's Name ... . .. ..... .. ........... ........4..................... --- Phone._......... ......_.. . ........................... Addres....... .......... ------------ Contractor's _-----4vx_................ ...... Phone.....................---------- Installation will serve: Residence P& Apartment House (3 Commercial ❑ Trailer Court [3 Motel ❑ Other 0 Number of living units: ........ Number of bedrooms Y_Number of baths ..12—Lot size ...... ....... Water Supply: Public system [_-] Community system El Privateer,Depth to Water Table _gr if. Character of soil to a depth of 3 feet. Sand ❑ Gravel 0 Sandy Loam" Clay Loam(:I Clay[I ' Adobe 0 Hardpan 0 Previous Application Made: [If yes,dote.-..... No 1j, Now Construction: Yes P No [I PHA/VA- Yeso,❑ No 0 V '' TYPE OF INSTALLATION AND SPECIFICATIONS.- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Distance from nearest well.......2-Ii'.Distance f;om foundation....../0.......Material 1,e No, of corripartments... .VSj,e.... .....Liquid depth..._..,. a,, 7'� 6 �_0 S.. . Disposal,��' d, Distance from neart w 11 Distance from founclation....../0--....Distance to nearest lot line_._ .r__" Number of iines Length of each Width of trench...... "o X 7?", Type of filter material...)?,o%*1L.......Depth of filter material0jj-g,,,-0-....Total length.......... ......... 3- Seepage Pit- Distance to nearest we'!.....................Distance from foundation----_. --_------Distance to nearest lot line................. D Number of pits...__.-.........Lining rnateria!,.... .., _ Size: Diameter........._. _ __..Depth...._.__...,..........._....... Cesspool: Distance from nearest well.................Distance from foundat'ion...................Lining maturial.................................. 13 S,'ze. .........................Depth.................................................Liquid Capacity.-_.....---------gals, V Privy- Distance from nearest well........... ............ ..Distance from nearest building.........---_-------_-------- 0 Distance to nearest lot line............. ............................................ ..................... ............... Remodeling and/or repairing ................. ............ ........ # .... ............. ................ ................................. .... ......... .. cerfiY prepared this app i- d that the work will be done in accordance with, San Joaquin County I hereb rke, ordinances. Late low and rules and regu0ons of th"an Joaquin Local Health District. ------- ........... ...... ...40wn*r and/or Contractor) By:.......................................................................................................................... ................... ........... (plot plan, showing size of lot location of system in rotation to wells, builidiings, etc, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY......... .... ........... DATE. _......---- REVIEWED DATE. ................ ................... REVIEWED BY_....... ............... .. .... BUILDINGPERMIT ISSUED..... ................... .......... ...........- *--------____ DATE...... ......_._................................. Alfereflom and/or recomrriendaHons:............ .......................................................................................—---------------------------------------- ..............................I—..........................................................................................................................................--__-_-!j,#........ ............................ .. . ......................... ........_..............................................-.1-11-............... .;lt . .. ............................ ............................. ............ .......................................................-1 ....................................... ;K .................__..._............................... .................I.................................................................................... ............A Date.. FINAL INSPECTION BY:....: .......111-1.......... ........... ... .......... SAN JOAPUIN LOCAL HEALTH DISTRICT 1601 C,14azolton Ave. 300 West Oak street 124 Sycamore Street 205 V Stacklon,California tisell,California Manteca,California