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FOR OFFICE USE: ----------------------------------------------------- =--- ------ --- ----------- -----------------------"-_------- APPLICATION FOR SANITATION PERMIT Permit No. ... .7 . - --------------------------- --------- --------------- (Complete in Duplicate) -------------------------------------------------------------' This Permit Expires 1•Year From Date Issued 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--------S1.2__CCtr_::_.S-R.,Manteca_ d: --Yerta .-RdR,Manteca-......... r30—I2- Owner's Name------3j!;K n•-1'e1e s--------------- ------ - Phone------------------------------------ Address-.------- -------------------- - -- Address-.------- Route 2, Box 297 r Manteca --------------- ---------------------- Contractor's Name----------same----------------------------- ------ Phone------------------------ 4 i Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ __ Number of bedrooms ---2- Number of baths ____1__ Lot size ____K4. 9----------------------------------------- Water ------------------------- -----------Water Supply: Public system ❑ Community system ❑ Private Ig Depth to Water Table ___1z ft. Character of soil to a depth of 3 feet: Sand ® Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,tdate____..___._,_.__.__) No [29 New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permiffed if public sewer is available within 200 feet.) =-Septic�-Tank c=Distance fro—nearest=well:750 *OtstanceYfromTfounda#ion-9 in =- 1 �" - - ---------------------- ® No. of compartments----2-------------------Size---9:5x3-----------------Liquid depth-------4--------- Capacity 80-----0------- -- ____--Ca aci --- Disposal Field: Distancefrom nearest well---50r__migistance from foundation___10`___minDistance to nearest lot line-----5--- in.�j ` Number of lines_______2-------------_-----------Length of each line----4_Q!_F4t?-'_,.7�'Width of trench_.___.24t*----_-_••_-----_----_ "�' Type of filter-:material---S AdliC>t-------Depth of filter material----12..............Total length--------9Q t___________________________ Seepage Pit: Distance to nearest well-------------_--------Distance from foundation.........:......___.Distance to nearest lot line------_.___--__-- { ❑ Number of.pits-----------------------Lining material--------------------------Size: Diameter-----------------------Depth.---- ----_- a Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material----------.--------.-__-__.-________- ❑ Size: Diameter--i----- ------Depth-'-------i-----------------------------------------Liquid Capacity.--------------------------gals. h Privy.` Distance from nearest well-------------------------------------------------Distance from nearest building---------------------.--------------------- ❑ _ Distance to newest lot line------------------------------------=-------------------------------------------------------- --------------------------------------------- Remodeling and/or repairing {describel--------------------------------- :-__-------------------.-......•------------------------------------ " 'i --------------------- --: ------- --------------------------•--- - --------------------•--------•---------------------------------••--------•------------•-•-------------------•.----------- ------------- F . ------------------------------------------ -----------------------------•-_--- -----------•---------------•..............-------------------------•---....----------------------•------- -------------------------------- I hereby certify that I have prepared this-application-and that the work`will-bedone-in accordance with San Joaquin County ordinances, State lad, nd rules and regulations a San Joaquin Local Health District. (Si nod ___ ________________.Owner and/or Contractor gY� -----------------------------------•'-------------------------------------- "----. ------•--------------•---•------------[Title)----------------•---------- .------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings. etc., can beplacedon reverse'side). FOR DEPARt WNT USE ON Y - APPLICATION ACCEPTED BY-------------------------- -------------------------------- -- DATE------.Dune--2*---1901-. REVIEWEDBY------------------------------------------ --------------------------------------- - --------------------- DATE---------------------------------- ------------------------ BUILDING PERMIT ISSUED_-•---•---- = — --------------- DATE------------------------- ---------------------------------------- and/or recommendations---- ` -----__ -----= ------------� � -----------•-------------•---------•------.------------•--------------------------•-•-•------.- ------------------------------ ------ -- ---- ------- ------ - -- ---- - -------------------------------------------------------------------------- ----------------------------- -- --- - --------------- FINAL INSPEC ---------------- Date --------------- FINAL �' 'SAN 'JOAQUI•N .LOCAL HEALTH DISTRICT 130 South American Street t 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California I Lodi,California Manteca,California Tracy,California E8.9 V,BED B-59 F.P.CO.2m 6.60 `