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APPLICATION FOR SANITATION PERMIT Permit No. ..`�:�- 7- /..q / (Complete in Duplicate) Date Issued [47- p2o-o ApplicaFion is hereby made to the San Joaquin Local Health District for a permit to construct and insfall +he work erein described. This is made in compliance with County Ordinance No. 549. North Avenue Estates t Manteca. uvts AuuRESS AND LOCATION:.::_ FiTst_.-house_..0410 ;0 on -_NOT __AV�.,....ju-$t........ .-.Fast.._off-_Hj--HaX...49.... Owne'r's Name .................... -- Mr-,-. Jaek..Tom� lnson-------- ............. Phone..HQ_.4t75 �5. . Address------2�1-E'-Mtle,_Street_�-_Stoekton_a - - - PhoneHD_.fi-9607 Contractor's Name---------------------------- PRR�S�i IN��-- - -" -- --- Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other I] Number of living units: 1.... Number of bedrooms ...3- . Number of baths .1.._ Lot size .-_240'-_.i._-7------- Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam ME Clay Loam [I Clay ❑ Adobe C]Hardpan Cl Previous Application Made: Yes ❑ NoXX New Construction: Yes ZK No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ _(Np septic fank or cesspool permitted if public sewer is available within 200 feet.) IQ!......M +anal---CC__Bx ck- Septic Tank: Distance from nearest we11...5Q1-..---.Distance from foundationLiquid �Qp Gal$, Err X5.6".......0 ...Liquid depth -- ..............---.Capaaty-- - -------- No. of compartments_ 2,__-_.--.'-.--.----Size9;;-ase� q undaflon --- � I P� t Disposal Field: Distance from nearest wet150._..........Diis onceo{reoam bine 75.1..__ .--p ....Width ofttrenche2It......... line -51 ...... XKJNumber of lines ---.._2 ......................... g ts Type of filter material.lflr....Rk....-.Depth of filter material...) a -------------Total length ...... 1rQ..------------ Type i . Seepage Pit: Distance to nearest well.._...__.".........Dis+ante from foundation_.._:...............Distance toDepthnearest lot line ____._. _:..-..-- ❑ Number of pits......................Lining material ............... ........Size: Diameter....................... Cesspool: Distance from nearest well ............ ---- from foundation............_ --__Lining material --- ------ gals' ❑ - Size: Diameter------ Depth --- ...----------------------------"- .......... Liquid Capacity........... --------------- Privy: Distance from nearest well ---------------------------------------------_..Distance from nearest building......... ---._. ❑r Distance to nearestot�line..:.:.._-----------------^-------"------------------___..---^--..._ "".:------..._—..,--- .........................--- S ecfcati-ons-__approved_ fora bedroom--.ouse Remodeling and/or repairing (describe):_...._^p--FTTA ander of Said -house,. -- - -- - ---------• ------------------.............................. 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County DARKTAH TNC. JfJra � Contractor) ordinances, State laws, and rules and regulation f the San Joaqui Local Health District. (Plot plan. showing sirs of lot, location of in relation to wellsAbuildings, etc., can be placed on reverse ei e. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------- REVIEWEDBY ------------- ------------------------------- ------------ - BUILDING PERMIT ISSUED ------ --------------------------- .._- Alterations and/or recommendations: .............. ........ .. _-------•---_------ FINAL INSPECTION BY:. - "' Date.....L./..4�.... -_------- - --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North '•C" Street 130 SoAmerican Street 300 WOak Street Trac California Stockton, California Lodi,. California Manteca, California y�