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FOR OFFICE USE: v 5 S� --------------------- -- APPLICATION FOR SANITATION PERMIT Permit No. _..rte_--••- - - - ____. .. --------- (Complete in Duplicate) _. .,. Date Issued _21--- ----------- ----------------- —+•-T--"`°`- �"'" 'Y This"Permit Expires 1 Year From Date Issued ------ --- Application is hereby made to the San'Joaquin Local Healfh District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. - I f JOB ADDRESS AND LOCA TI one �- 3 --------- -------- -•--•. - -- Owner.s.Name._..__Y ---•----•-- _ r } --------------:_ ----------------------------- ------------------ ----------- Address 1 - 1 � l one ------------ Contractor'si /.. - ------=---------•---------------------- Phone Contractors Name:.-=----- - :_;€ -,��.4d•Z� i serve: _'Residenee,❑ Apartment House❑ Commercial Trailer Court ❑ Motels❑ Other ❑(5� l Installation will se : �, / X k Num6r$f livingIr`''nits:4_------- Number. of bedrooms -------- Number of baths ./.-____ Lot size ..... __-----_---j___-_-- Water Supply: Public system X,'Community system E] Private ❑; Depth to Water Table 5-yft• Adobe Hardpan ❑ Gravel Sand Loam ❑ Clay Loam Cle ❑. Character of soils a depth of. feet: Sand ❑ ❑ Y EMANA: Yes F! No Previous Application Made::(if yesrdate-__ ) No �. jNew Construction: Yes .No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic;tank'or cesspool permitted if-public sewer is available'within.200 feet . t„_ l ; i aVlagrial + 1 C� Y Septic Tank:• Distance from nearest well_ `�t-Q=_Distance`from f�unda�Li -------- on-ole _tel Capacity-- --•---- No. of.compartments...___ Size-3-- 5 `Jr Liquid depth--- , Y ... O I n lin Disposal Field: Distance from nearest welly ��.Distance from foundation .Q". -- -•W dth of trench estd� i - r-� ` Length of each line-------- - s . Number of lines -- _.-_� --- --- •- De th of filter materia! ... , Total length"....... .... .----------------- -'Depth .. .Type of-filtei material -. � _� P _. .., - . - _ � . t _ k f Seepage Pit: Distances to. nearest well . `±^-�---Distance from foundation .J� D�tan fe to lotli Numberwof pits.:"-- ------------Lining materia :- ize: Dfiameter..�_ef`k. 'SDepth._-___� ...... r� `Distance from foun atiom.:;;------- "Lining material---------- ----------- ----•-•- Cesspool: Distance frorn�rne, , well___ ,..i. r -Depth -- �A-Liquid Capacity------ � gals. i ❑ Size: Diameter.. :----- --- - P Y j -_ : Distance from nearest building._-----"-.... _. y; Distance well_..." - Priv ----- Distance to nearest lot line----------------=------------------------------ - C" ❑ ----------------- r _ . . scRemod n and or. re airing ti 3 -- 1 =-__-- ----- - ------ ______________ ----- � -- --_ _ _-----....--._...-- ---------------------- --- - an o esun y i '- I hereby certify that I hsve�prepared this'appiication and`that +he work will be done in a�coTd�?+ce with Sr_�J Ysquin' 'f ,' ordinances, St to latus,°-and rules an re-gul ins of the"San Joaquin Local Heil#h Dis#r1c . ;. . i f ' + i (�. - "`. -^ --- (Owner an Contractor] ---- ---- --- -- ---- - " -_"-- "-(Owe and/;r (Slgned)_ - ! d� ------------------- - = '----(Title] ----------------- -------- :-- r --------••--------- ----- •--------------------•--- -------------- ------------------- By(Plot plan, showing size of lot', location of system in relation to wells, buildings, etc.;'�can be placeii,on reverse side]. I FOR DEPARTMENT USE ONLY i 1 k p ----------- �— i� DATE_- }. - _::. APPLICATION ACCEPTED:BY._. --- , , i i = - = DATE,_- _`=-- ' REVIEWED BY -= - :._ DATE. - :' .�: BUILDING PERMIT 155UED - ----• ------- ------------•.-- Alterations and/or recommendations = -- '. ----------------------------- --- -- r --------------------- '9:-. --------- - ...-------'i.ti -----_.----. --------- ...-_. --- ------ -- - ------------ -----------Date:;- Lam. . . .. .----------- -------- ------------ .. FINAL INSPECTION BY:._-___-- - --- - - ` - - ------- ------- ----•---- •SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wert Oak Street t �.r`�. _�-i 24_Sycamore Streets `a 305 West 91h Street 130 South American Street I Tracy,California Stockton,California Lodi,California :> "3 1 1 }Manteca,California Yr y 1 E5.9 RMEED 9.58