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Permit No.3. ._7.`'_L---- ` APPLICATION FOR SANITATION PERMIT j � _ (Complete in Duplicate) Data Issued } A licafiion 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 incompliance with County Ordinance No. 549. 13333---F, XarEi1> } Y------------------------------------------�-------------- JOB ADDRESS AND LOCATION_..1 h -------------- Phone--- 7 ---------- C, --------- ---------------------- Owner's Name--------------------- ------------- IQ H S_ame-------------------•-------------•---------•-•-------------------•---�---------------------------�----------•-------------•-------------••------ Address.-- ---•------•---- pone.------�-2 q7----------- Contractor's ---- --•--Contractor's Name----------------------------- Other Apartment House ❑ ' Commercial E] Trailer Court ❑ Motel ❑ Installation will serve: Residence [� Ap 6Q; � 100 --.--.- Number of living units: --�•-_- Number of bedroomsZ-_-._-- Number of baths .---__- Lot size ---------------------- ----�------------------------- Private ❑ Depth to Wafter Table ._.4a?t. Water Supply: Public system ® Community system [ICla Loam ❑ Clay ❑ Adobe [J* Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel [ISandyLoam ❑ Y Previous Application Made: Yes ❑ No X] New Construction: Yes [N No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 101 Material---------- ---------Brick - Septic Tank: Distance from nearest well--- from foundation depth----------5.2j---------Capacity8a --- -- No. of compartments--- 1------- -----Size_------ ---H- � _ a ea � 1 Disposal Field: Distance {rom nearest well Distance ?rom toun�ation- �_------.-.-.Distance to nearest lo` line--"_- DispLen th of each line----___-2()l--------------Width of trench--- -------------------------- r V� Number,o-i lines------'------I----- ------- g 1 1 RYDe th of filter material----�»8��-..-------7ota1 length----2.----------�---------------------- Type of filter smaterial---_-------�' p i t Pit: gistance to nearest we44-- � e---- ---Distance from foundation_--.40.-----•--.Distance to nearest lot line Pi 3311 Depth---.2 t--------------------- ®n Number of pits--------�------------Lining material- Q`_.Bx' -G_- ize: Diame meter ---- - - - --- Y Distance from nearest well---------------_gistance from foundation--_._------..-- ..Lining material--------_------------------__---als. Cesspool: -Liquid Capacity-----------------_---------g Size: Diameter--------------------------- ----------Depth----------------------------------- ❑ Distance from nearest building------------------------------------------ Privy: Distance from nearest well------------------------ -- --- ❑ �� Distance to nearest lot line"-------------------- -- ----------------- -- #4 --------------------- ------------------------------------- -------------------------------------- -------------- --------------- Remodeling and/or repairing (describe): - -__-__-. ----••-------------------- ----------•- ------------ ---------------------I-------------------------------•---k------------------ `------------------------- ------------------------------------------------------ • cco o - i I hereby certify that I have prepared +hiIli the Sand that i the work willHeabeDis ne i accordance with San .loaquin County ordinances, State laws, and rules and regulations PARR -S ------ '---------- --------------------------------------------------- ---------- (O �# Contractor[ ------------------(Signed)--------------- 1 ------(Title)-----Egt3.ty�tar $Y� -- ---- ---------•-------------------------- (Plot plan, showing 'ze of lot, Iota#ion of sys#e in relation to wells, buildings, etc can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------------ DATE-� ---------------------------------- ------- -- --- --- ----------- -- APPLICATION ACCEPTED BY._._. . DATE--- --------------------------------------------------- ------- . 1 --------- -------------------------- REVIEWED 13Y=--------------------------- - DATE. -- V ------------------------- BUILDING PERMIT ISSUED----------------- ---------------- -----------•------- -----------------------------------•---------------•------- Alterations and/or.recommendations:--_----.--- ----- --------------------------------------------------------- ------- i •--••-------•----- ' Date.. . I -----------------------------•---•--- FINAL INSPECTION . :------ ----- ----�-- -"-"" �------•-- �+ SAN JOAQUIN LOCAL HEALTH DISTRICT 132 sycamore Street 814 North "C" Street 300 Wes} Oak Street 130 South American Street Manteca, California Traey, California Stockton, California Lodi, California ES--9-2M Fo-s2 Revised W-2100