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(� _ FO OFFICE S � Q 7 /----alm APPLICATION FOR SANITATION PERMIT Permit No. _�--f F 1 r --- -�✓� ---- --- '- Complete in Duplicate) Date issued ------ -- - ---- ---- -------"----- This Permit Ex ires 1 Year From Date lssued ----- ------------ reb made to the San Joaquin Local Health District49 a per to const�u and in mit w 3-n�;ir e . p,pplication is hereby �� This application is made in compliance with County Ordinance No. !7 11"---dwo r_ � - f`-'� ----------- JOB ADDRESS AND LOCATION. __ B -------------------------------- Phone------------- --�. -- ----- - ----- -- -- ------ ,�.r�7a �------ ----- a Owner's Name.------ - , 'Q_r�r -"------- --------------- , Address Phone. ,s - ��_ _ ._ Other ❑ Con#ractor's Name___..._"__._ ---•--• - -- Motel ❑ Commercial ❑ Trailer Court ❑ Installation will serve: Residence Apartment House ` ------ -_ - Number of baths .A"- Lot size _-- Number of living units: _/-- Number of bedrooms��lvate �apth to Water Table t�Q{}• Water Supply: Public system ❑ Community system ❑ Adobe�ardpan ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Character of soil to a depth of 3 feet: Sand ❑ ----New Construction: Yes 2?-ONo ❑ FHA/VA: Yes W,-No ❑ Previous Application Made: (If yes,date--------------------) No p TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet-) tioa -------.Mat Material- © -------------- unda Distancedepth from nearest well--- S,Jzear from q p ' No. of compartments__------ 1 "--.-__"--Distance to nearest lot linelr --------• ` Distance from foundation -- .----_ -- --Length of each line_-F----------- ----------Width of trench-!1___-------�;-•-------- -------- Disposal Field: Distance from nearest well__�'� -- - �/' Number of lines------- ~ ,� '�_-De th of filter material__� ------------TOtal length---,la��------------��"'---- Type of filter material p �� Distice to nearest lot Ike 0 .----------- . Distance m f ndation-- _- r� .-- Seepage Pit: Distance to nearest well-_� -- - Size: Diameter.r >�-------- Depth"r2s - - --- I Linin material. __ _ Number of its___. - g Cesspool: Distance from nearest well-------------- Distance tfrom foundation--------------------Lilquid Capacity_.------ -------gals. ❑ Size: Diameter-------------------- ----- P Distance from nearest building----------------------------- ---------- Privy: Distance from nearest well--------------- ------------------------------- ------------------------ --------- --- ------------------------------ ------------------------- ❑ Dis#ante to nearest loft line...__.--- -- , -------------------- Remodeling and/or repairing (describe):----------- - ------------------------------.__.__.------------------ ------- ------------------- __ _______________________ f ___________________________________________________________________________________ T ___- -------------------------------------------------------------------------------------- I hereby certify that I have prepared u`aisons lli the San JoaquinhL cal HeallfiheDistrictn accordance with San Joaquin County ordinances, State laws, and rules nd reg (Qor Contractor) - (Signed)------------"----------- --�- ---(Title}_... - - - - ----- ------ ------- - By--------------------------- ---------------- - -------------------------- (Plot plan, showing size of lot, location of system in re n to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - --- - � --. ----- DATE /L -Z3 —�J------------------ --------------- -- --- ----- DATE—-------------------------------- - -REVII WED BY ------------------------ ----- DATE---------------------------------------------- -------- BUILDING PERMIT ISSUED------- ---------------------- f.=, ------- - --�------�' >y Y3 _ -------- - -----------•-------------- Aiterations and/or recommendations:____- - ----------------------------------------•-------------•---------- ------------------------- ---------------- ----------------- - ------------------ --------------------------- ----------------------------- FINAL- INSPECTION SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Manteca,California `, Tracy,California Stockton,California Lodi,California F.P.Cq.