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FOROFFICE USE � --------------------------------------------------------- APPLICATION FOR,SANITATION PERMIT, Permit No. (Complete ` ' Da Issued -..!�.��.l6x 7 Application is honm6v mu6m to the Son Joaquin Local HonHh District for u permit to construct mnAl�Hhowo, herein described. This application ismade incompliance with County (}n]iNo. 549 JOB ADDRESS AN LO CAT 10 J_ - ------- -------------------- ~-~� ' �� . |m�|�� w�| serve. Residence � A��nrnou� Commercial E] Trailer Court � Motel 0 Other . �� Number of |i�ng units: _/--- Number ofbedrooms �� Num6o -^- Lot size --------.-_-----_- Water Supply: Public system C] Community system El Private ZDepth to Water ft. Character ofsoil to a6aoth of 3 feet: Sand E] Gro"v| E] Sandy Loom [l Clay Loom Clay Adobe L] Hardpan �] Previous Application Made: (If yes,date----------- --------) No E] New Construction Yes E] No E] FHA/VA. Yes E] No El TYPE OF INSTALLATION AND SPBC\F(CAT|ONS: (No septic tank or coxspnn| permitted if public sewer is available within 200 feet.) , Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ----------------- ----- El No. ofcompartments--------------------------Size------------------------- ------Liquid nuu�� *� ~ " 6=�h--_-----Cmpoc�y------------------------ Disposal/Field: ---._-~ D � o�� Distance neuny� *cK'~� -'.D�tunce from foundation 49../-'Distance tonoum,t �t | ,_' � Number of |/"e� uang+6 of each hmo`.'6,Z-~'--.-_ V�6+ of trench ' ''~' � 'Type of filter moD�o� o� �|�r mo�,�\ a� ^~ To�| |�ng� ----- Seepage "w Pit: Distance to nearest woL_--'--D|stvnce from foundation--------------------Distance fo nearest lot line----_- ` El Number ofpits -''''—'—Lining material -�''� --- --- Size: Diameter--_'�_----Depth------ -''-'--'�~' � Cuuq»oo|: Distance from nearest well-----------------Distance from foundation--------------------Lining material -----.---_— El Size: Diome+er!�----------------------------''Dept h—''''-'�'''--�� --��'-Liquid Capacity-'-''-'---'-gals. Privy: Distance from �earesfwell----- -------------------------------------- from nearest building ~---._._----- [_1 Distance to neonesf,Jot line-, --- �—��-'''�� —'— -------------------------------------------------------------- ------------- --------_' � Remodeling and/or repairing (describa):------ ----------------------------------------------------------------------------------------- -------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- ---''----'----'---------'--'--'-------- -------------------------------------- - ' - ^- _r.-----'___.'''----.'-''-_''''_- '-__.�''--''_�_,_'''-_.''__.--____----._-�.._---------. —'--_.'__-''''-''--''-''-_''-----''-_-.'_-.'''_-_'''--''-_.-'-_.'''__--'''-''--__--''-'-''-'--(Si ^ I hereby ce fify,that I have prepared this application and-thafthe work will be done in accordance'with San Joaquin County ordinances. Sta I s, and rules/'and regulations he,,San JA6inL6cal Health District. rw' e~+' ~. --------------- ^~------,��_____�,,~`�:�. ~,~",. Contractor) , � - - -uy�_- x'zr��. .. --' ' ..�_--_-_--- ------------------ 'el 11 plan, showing size of lot, location of system in U � ef�..nan6� place6 on re,erm, siQL FOR DEPARTMENT USE ONLY RGY|EWED BY------------------------ ---- --------------------------- ------ -------------- --------- ------------------_-.. DATE-------------- -__---_--__—_.- 8U|LD|NG PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE'-'-'----'''-'�-'''-'-_-'- A]fmruNnnu and/or recommendations:------------------------------------------------------------------------------- ------------------------------------------------------------------ ----------- --------------------------------- ---------------'----------'--------'----''--'------------' ��_--- ------------------- ---------------------------------- ------------- ---------------------------------------------------------------------------------------- -------- ---------------------------- -------------------'-----'----'----------------'---------------r-------------'----' --__---_---_---_--------__--------------------_-------__-----___-------'-----------___�----_-----_-----------___---___-------_--------__-------___��_------------------_��---_---_ FINAL INSPECTION -''-''—' Date--�— ------!� --.------ ----------- '_''''--'-'-' SAN JOAQU|N LOCAL HEALTH DISTRICT 1601 aHazelton Ave. onuWest Oak Street ,o*Sycamore street xusWest 9th Street e"mm°'California L"a/,California Manteca,California Tracy,California ES 9 °".=*D B'°" 3" 3''63 ,.~=E3.