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_� FOR OFFICE USE: � Permit No. --- APPLICATION FOR SANITATION PERMIT •-- •��` [Complete in Duplicate] Date Issued . ----`�� "# This Permit Ex fires 1 Year From Date Issued ��s 6&C)--- 4?f liion is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. q PPcafi. This application is made in com lianc th Count Or inance No. 549. r p _ / _ �] < ' S.2 (7' c.u r5 4 �'i��J I C' `' `t"C J JOB ADDRESS AND ATION--= - ..�Q,t�[.�U%A)...CC....... Phone----------------------------------- ... Owner s Name---- _Q1� - - 1 --- / c { a - --- 1D_ � ------- --------- one - --------- Address_- .- t Kip -- Contractor's Name--- Mo}el ❑ Other InstalVation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Number of living units: ------- Number bedrooms .__-__-_ Number of baths ber Lot __,< --- -------------------------- i t Rrivate r�Depth to Water Table�Z_ ft. m i Water Supply: Public system ❑ Comunity system ❑ Adobe❑ Hardpan ❑ f erecter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Ch _ FHA/VA: Yes ❑ No Previous Application Made: (if yes,date_�'"-7 - 1 � o New Cons ruction: s es No ❑ Prev PP TYPE OF...iNSTALLATION�ANDo Pe ml FICA ifOpubtic sewe r availab hin 200 feet.] f u (No septic tank or cesspool i /,$- --_Material_ ---- --- m foundation--___-- - �� f t Capacity Septic Tank: Distance from ,.nearest weIID00-- Dizt r �p 1 '-Liquid depth._-�o2- --------- P y No. of compartments___s------- --------- - If ----i } ---- r Fr Disposal 1 field: Distance from neares well._-�v----Distance from foundation/.}. r� Width ofnce ttrench-_ line --1-5 Number of line------ ------------Length of each line.__ltr- �`f' ` + y G kt it Total length---,�~� t ... t Type of filter materiaLk__ �_-.Q@��Depth of filter material____- I l -.Distance ce to nearest lot lire- i De tn_ . Seepage Pit: Dis#ante to nearest wel!__-�-��J----- --Distance from foundation___- - �� p � �-. Nu ber of pits fining material._> f1-GK-_---size: Diameter-_. f Distance frominearest well----- from foundatio F---_--_1-"-___Liquid Capacity ------gals; E Cesspool: De th_._-_ k Size. Diameter -------------------- -- P ❑ Distanee%4-orl, nearest bui4ding-- ----------------- E �' R- --•-��Distance,from nearest well ------------- PrivyPrivr ,r �. - ------- ---- ---- q .:, ------- �------- ------------- .' � _.Distance=to nearest-lot:_I,ine -d-- .�� -------- a �"jor ',e ai' ...____ - ________________________ Remodels hg'and/orrre ainn (d ibe�:.__ w r '� `fir ---------- ----- •. �` ------ -------------- r ` �....»........ +�+"+►+•+ �"� - __.__ _ 1 --------------------- ____________________________________________________________________________,___ �e _______.___._______ _________ ____________ .1 f at _ 1. _ i r - ' 'ire aredTthis.a lication and that'the work wild be done in accordance with San Joaquin County � lihereby certify,tha ve«P P- PP � �- ordinances, State law and ru and regulations of the San Joaquin Local Health District. _-_. - isM n _ -t _[Signed)----- ... F --�• - �s^ -- -- ---- l .- and/or _ - � -;� -(Title)- who . .... ---- " . ---------------- id - (Plot.plan, s[►awing"sizeoflot,-of -system'in�relation to wells, buildings, etc., can be placed n reverse side]. �R FOR DEPARTMENT USE ONLY ' DATE_x.S-'.a—.. cra.L ----------- ------------- ----------------•------- ' APPLICATION ACCEPTED BY -------------- -- DATE--------------- 1---------------------------- ------- - -------------------- ------------- REVIEWEDBY------ ----- ------ -------�- --- --- --- - --------- DATE--------�----------------- ---- -------- --------------- BUILDING PERMIT ISSUED`-----'=l------------------------= ---------- -------------- .. € t ----------------------------------------------------- ---------------- Alterations and/or recommendations--- ---------------------- -------------------------------------------------------------•-------------------------- ------------------------------------------:- ---------------------------------------------- iI --- --------•----- 4 ----- --------------------- -------------------------------- ---------------------------- - - _.... - ---- ---------------- . Date---S' 4---- _. ---- -----_. -------- ---------- - FINAL INSPECTION ----- --- -" SAN JOAQUIN LOCAL HEALTH DISTRICT -1 300 West Oak street 124 Sycamore street 205 West 9th Street 1601 e;Hazelton Ave. Manteca,California Tracy,California Lodi,California stocirton,California F.P.C C.