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US FOR OFFICE E: APPLICATION FOR SANITATION PERMIT Permit No. .�• ------------------------ ------- (Complete in Duplicate) Date Issued�.� --_---- --- �+ -------------------------- -- : ---- "--- -- This Rermif Ex ir'es a Year From Date Issue -------------- ---- "---------- ermit to construct and install the work herein described. , Application is hereby made to the San Joaquin Local Health District ora p This applica#ion is made in compliance wit o14nt Ordinance No. 549. fir ------ � -- JOB ADDRESS AN OCATION.... - ---- Phone----------------------- e Name.---- - -- �- -- ---` •-- ------------------•----- ----------- r� -----------------------------•-------------------------------- a Owned r -------------------- Address------------ -`O-. ------ ----------------------------- - Phone.. -- � - i . ,��---- ----------------------------------- Other ❑ Cont act%,'s ,Narme----------- Trailer Court ❑ Motel'❑ �,� Commercial ❑ Installation will serve: Residence �"`partment House Number of baths--- Lot size I ew I Number of living units: _1--- Number of bedrooms -- Depth to Water Table 170 ft. Community system ❑ Private ❑ P �ardpan ❑ Water Supply: Public system � Cla Loam ❑ Clay ❑�r.Adobe Gravel ❑ Sand Loam ❑ Y ❑ FHA/VA: Yes ❑ Y Character of soil to a depth of 3 feet: Sand ❑ l No ,New Construction: Yes l�o r Previous Application Made: [if yes,date--------- ------- a OF INSTALLATION.AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee Mat vial-- f�G --"."`""' Barest well.-.--"�--- Distance fr m foundation-_/ TYPE from n %c ' id depth_ -- -------- Capautyh? �� t Septic Tank: Q+stance ,1 f/�----- ,tee 1r / Size",/- ---- l No. of compartments._,_ -- --- Distance to nearest lot line- ristance �if . Disposal Field: Distance from nearej# well.` - �ength ofre ch 1 fu Width Wsdth of trench. ---- `--- Number of lines--J_----.-f----- - � * Total length.A-pp-=-------------------�- I Type of filter material/t- of filter materna!_" --- - i '� I ' S 1" .... .. ........Size: Diamete;X do .Dep Number -------------- it: Distance to nearest well._"..-"�:. ----- Distance from fo�ndation._f�•--'- Dista to nearest of ir;,e.----- o �� ----Lining materia ' � ❑ Number of pits--,��------ --- f 7 Depth------ �;----Liquid'Capacity_ ----------------ga4s. Cesspool: Distance from nearest well.................Distance from foundation.__...:+ .--- --.Lining materia`_----_--"---- ❑ Size: Diameter------ ------------- Dep ? r _ !stance from nea-rest,building Distance from nearest well---------------- ------------------- ----- ------------------------------------------ ----------------- Distance to nearest lot line------------------------------------ -------- ------M_-- Remodeling and/or repairing (describe):-------- "-e-4 ----.a 1 5 ---------------k------------------------- ----- ------------- I hereb certify that I have prepared this application and that.the workkwial`heD one in accordance with San Joaquin County Y ordinances, State laws, and rules and regulations of the San Joaquin Local He is#nc . r -- -- ------ ------ -= —Contractor) , __. (Signed) •p -----------------------(Title)- By: Titl �? zr ----- ------•------------------- - �_.,:�.: e) [Plot pian, showing size of lot, location of system in ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I r APPLICATION ACCEPTED BY.. -------------------------------------------- DATE- ----------------------------- - - = DATE--_------------------•----------------------------------- REVIEWED BY------------------------------------------ -------- --------------------------- ---------------- DATE__ -- ----------------------------- BU 1 LD1 NG PERMIT ISSUED------------------------------------------ Alterations and/or recommendations:------- ------------- - ------------------ -------- -------------------- -------------- ------- -------------------------------- ------• --------- -------------------•-------------------------------------- ------------------- �'" --------------------- - Date.- - - FINAL INSPECTION BY:. `�` --- ---------- ---- --- -�----- — A- SAN JOAQUIN LOCAL HEALTH DISTRICT ]I� 300 West Oak Street 124 Sycamore Street' # 205 West 9th Street 1801 E.Haselton Ave. i l LodCalifornia Manteca,California Tracy,Californiai, 5lockfon,California � �.s