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FOR OFFICE USE: te . . ---------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 6Z ------------ -- ---------------------------------------- Ila-2Z ------------------------------------------ (Complete in Duplicate) Date issued --- ----- ---------------.---------------...........___ __ This Permit Expires 1 Year From Date Issued Application 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 in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--/-------:225 --- ----iM -fF--T:-----------------------------------------------i-MANTE_C_/---_---- Owner's Name------- __�_! 'T Q f-t_ai '------------------------ Phone----_--------------------- -------- `'_2-�----------14n: L 1 -------------- M----------------- -----:---------- - Address---------------- 7C19 Contractor's Name_M#qjVT ._09. +EP 'OL--------S—aR '1------------ ------ Phone----------------------------------- Installation will serve: Residence ff' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __d____: Number of bedrooms_._ Number of baths-7—Lot size __/ Q�� ____n---_---__._---______--. .-,i- ---------- Water Supply: Public system ❑ Community syst ❑ Private �epth to Water Table _ _ ft, Character of soil to a depth of 3 feet: Sand Gravel ❑ Sand Loam❑ Clay Loam El Clay E] Adobe E] Hardpan ❑ , Previous Application Made: (lf yes,date____.-__-- ........) No New Construction: Yes ❑ No Z0""FHA/VA: Yes ❑ No&-1 TYPE OF INSTALLATION AND SPECIFICATIONS: .(No..sep+is +ank;or,cesspool,permittedzif public..sew.er,is_available-.within:`200.fee+.)-;, Septic Tank: Distance from nearest well_---------------Distance from foundation--------------------Material-.----.._----...-_.-------_----_----_-----.-----. i Size----------------- Liquid de th----:------------- ��i No. of compartments q P. Capacity Disposal Field: Distance from!nearest well_.. M-____Distance from foundation.._. ,._.______.Distance to nearest lot line_____�J.�.____ T/A(G Number of lines--------- -----------------------Length of each line___ Q+� Width of trench---------"Z oa ______________ ( -�— ADL> Type of filter material---]30-___K____Depth of filter material_-__L�7 _._____..TOtdl length--___ u --------------------.----__ I Seepage Pit: Distance to nearest well----------------------Distance from foundation._._.__._.._____._,Distance to nearest lot line------.-.-.___--. ❑ Number of pits----------------------Lining material----------.___-_------Size: Diameter------.-----------.----Depth---------------------------------- Cesspool: Distance from` nearest well_____._____-_-_-Distance from foundation._..-..._________.Lining material------------------------------------- El Size: Diameter- ----------------------- Depth-----------------------:------ ---------------------Liquid Capacity---------------------------gals.- Privy: Distance from nearest weEl...._-------------------------------------------Distance from nearest building-_________-_-______________-_____.._..._. ❑ Distance to nearest lot line----------------------------------------- -------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------- --------- -----------------------------•----------------------------------------------------------------------------------------------------- . �I --------------•---------------- -----•--------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------- --------------------------- 4 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereb i rtify th rI have 'rrepared this application and that the work will be done in accordance with San Joaquin County R ordinances, . ate law and rul and g lations of the San Joaquin Local Health District. {Signed - !L ff� -----------------------------------------------------------------------(Owner and/or Contractor) By:------------------------------•-------- ----------------------------------------------------------------------------- -------------(Title)---------------------------------------------- ----------------- (Plot plan, showing size of lot, location of sysfiem in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- 1__l1.. _------ ---------------------------------------------------- DATE----------- .' - --------------- REVIEWED BY- ------------------------------1---------------------- ----------------------------------------------------------------- DATE---------------------------- ------------ - ---------------- iBUILDING PERMIT ISSUED--------- I--------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations----------------- tt tt ------------------•-------------------------------------------•--------- -------------------- ------ ----------------------------------- ------•=---------- ----------------- •-------- ------------------------------------ „I ------ 4 FINAL INSPECTI ---- Date ------------------------------- SAN -SAN JOAQUIN LOCAL.HEALTH DISTRICT 1601 E.Hoselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1 Stockton,California Lodi,California Manteca,California Tracy,California r- F.P.CO.