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FOR OFFICE USE. 4 <br />....................... ­ ..... ................... <br />.... . ... . . ... . ......... ...... APPLICATION FOR SANITATION PERMIT Permit No. <br />�5z ..... <br />,7 <br />...... !his P*rmit Ex--cim I Year From Date Issued Date Issued <br />,icafi - <br />�on is hereby made to the San Joaquin Local Health Disfritf for a permit to construct and install the work herein described. <br />)nts application is made in compliance with County Ordinance No. 549. rk I z � I'%_ <br />JOB ADDRESS01 <br />CATION.__A;2 <br />All. <br />Owner's Nam <br />............. .... .............. . ......... <br />Address_.._.......17� <br />Contractors Name........ .. . .... ........... . ... ..... ... .... ... Phone. - <br />Installation wal serve: Residence Apartment House C] Co mercial [3 Trailer, C�urt El' Motel 0 Other C3 <br />Number of living units:._.,. Number of bedrooms <br />Number fbaths ._/... Lotl6i <br />Water Supply- Public system (3 commurfity systern'6 Private R�Pth To Wa4 Tablep.... ft. <br />Chwatter'of sog to a depth of 3 feet: Sand <br />®"Gravell] Sandy Loam EI Clay Loam W' Clay C1 Adobe C] Hardpan <br />Previous Application Made: (if yes, No [I Now Consfructton: Yes [I No [I F14A/VA. Yes C] No rl <br />TYPE OF INSTALLATION AND MIFICATtONS.. J <br />I V I , - <br />(No septic tank or cessP961 permitted if pubbc-s;iwer is ftV4ia'wffh1in 200 404 1 <br />Saptic Tank: Distanc9l"from nearest w"'ell'..- ............ Dstlence'iromi f&ndaflon... .. . ......... i. -Material ........ . ................. . . ........ <br />'arti <br />Cl No. of compai'hrients................ ........... . ...... ..Uquid depth . . ....................... Capacity—__.. <br />Dispospr Field Distance frim noarftst"welI" ... DiStan C6 fro l findation. Distance to nearest Ich <br />... <br />Number of lines ........... of trerich-_.Z.- ............. <br />Type of filter materiel-..`,r��_ . 5 <br />--Depth of 9tar material ........ 14 "..Tota! length ... ..... <br />Seep a ton- Distance to nearest lot <br />JI <br />.01 <br />Number of ts_ ...... 1 - Lining "'Size, 6ibi�eter Depth -...,Z I <br />/a Pit: Distance to Distance from f rj� t' LP� <br />Cesspool: Distance from nearest well ......... . . .. Distance from foundation . ....... Lining <br />........ Capacity <br />Distance from nearest well....._.... from nearest building..----_—__ <br />0 Distance fa nearest lot line. ........ <br />Remodeling and/or repair' <br />. .............. <br />- - -1 - - I -------• t ... . .. . .. - - - - - - - -..................... .. <br />�74 <br />..... ..... ­_._._.____­_­.. . . . . . .. . . ..... . ..................... ­ ..... . . ....... <br />I Iweby certify the+ I prepared this application and that +6, work will 6i do" in accordance with San Joaquin County <br />ok,firiance State la and les and regullitfions of +6 San Joaquin Local Hearth District. <br />.. . .. ........... 40wner and/or Contractor] <br />(Plot plan, showing also of W. location of-` ;�cm­ w ;,_uilldll�n. eta., ran be reverse side} <br />system - r <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED �_� . . ....... . ............. DATE .. &::�A <br />REVIEWEDBY............ .......... ___ ..... . ........ DAM_ ... _ ...... . .... —'*'*- - -------- * - - ------- <br />BUILDING PEP -MIT ISSUED. ....... . ..... ....................................... DATE ............... <br />Ahwatiortsand/or ................................................... .......... .. _'__...........».................., <br />.... . .......... . ..... ...... ...... . ..... <br />­ ..... -1.............>..............................,..,., <br />.............. ... . .................... <br />FINAL INSPECTION BY-4� ...... <br />D 0'e, j . . ........... <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South Arn*rltaa Street 300 Wart Oak sn"t 124 Sy oft Streit# 205 West %b Sft*o <br />stoickjan, califarnta L"11 Cailier»ta Manteca, C0111*MW Tva", California <br />ES 9 REVISED 8-59 2M 5-62 ATLAS <br />0 <br />