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OR FFICE Ute: . y'N �/ K 2. 3 D .-------"- APPLICATION'FOR SANITATION PERMIT Permit No. .17-:07. ------- ------ -------------------- t (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_____ ( ----------- / J � rC�G12�1._/r!1 �y1 -� i_ Owner's Name---------' ' F <1 �J i'c _ Address------------------------ zo-� ' , ------------------------------------------------------- Contractor's Name_. --0TH..... ..... ---•--•-------------------------=------------------------------------------------------- ------ Phone----------------------------------- Installation will serve: .-Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____1__ Number of bedrooms __^Z--Number of baths _f___.Lot size --- Water Supply: Public-system ❑ Community system ❑ Private epth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Graves ❑ Sate oam E] Clay Loam E] Clay E] Adobe ardpan El Previous Application Made: (If yes,date_-______-..__.__--) No Construction: Yes ❑ No p--11TA/VA: Yes ❑ No TYPE'OF INSTALLATION AND SPECIFICATIONS: (No septic tanks or cesspool permitfed if public sewer is available_within 200 feet.) Sep •c ank:J I Distance from nearest well___________ _____Distance from foundation--------------------Material ...--.-.-..---._-__---..-----------.--_.__----_. ( No. of compartments Size == Liquid depth- Capacity-------------------- ! / P ---- ---- q P j0 f �`!• Dis osal Field: Distance from nearest ell..�v-_-_.-Distance from foundation../' to nearest lot line_._ __--L-.--._. 3 [b]�^ Number of lines---------- —-- ------------------Length of each line--------- ---------Width of trench.-=;:)------------------- -C, ----- c_--_- tfI 5 pe_of filter material-__f j�/ E3epth.of filter material _. ___'Total length____�ll_ ! 16 Q ` , j Seepage Distance to neares well__ ____Distance fun ation_____� �� ' 07 --�___._ N .I Q._�__.Distance to nearest lot line-- __ Number of pits._`...............Lining maferial-_ Size: Diameter. Y.....-.Depth- 's Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- Size. --.---.Li uid Ca acit ❑ Size: Diameter Depth_ ti q P y- -gals. ; Privy: Distance fromnearest well_ v__,.-_------- DiMance from nearest building.`____________--------------- ____ ❑ Distance to nearest'lot line -- --- ----------------------------------------------------------------------------------------------------------------------- r. Remodeling and/or re airing (describe):----------- ---- --`_ ___-- -- _:- -l��rJrQ-------- -.---- fi.f //_� ------------- - �# ---- I. I ` . .___.---•--- ------------- +---------- --------- ------------------------ _ - - ------•-----------------------•--------------- -------------------------- ---------------------------------------- _ • ---- --- ------•------------ 3 A Y._._�.-._y-.�.�... '.'- .. - 1 hereby certify that f have prepare4d this application and +ha++he �work wide done in accordance with San Joaquin County �¢ ordinances,' State la s, nd.rules and 1 tions of'fhe San Joaquin Local Health Dis+rict. '�% " Own � (Signed))y ------•-- ---�-.-- ---- ----' i - --: "-- - - ,� ----( er.and/ar Contractor) Si ned ______ _ ._ ,C/ it i -------- (PlotIan, ---------•------------ ---- � -- - - -- - - -- - - - - --;---��---��Tl+le)------- - -------- ---� - ( p 'showing size to ocation of system in vela ion to wells, buildings, a+ .,;can be placed on reverse side). 1 FOR DEPARTMENTXSE ONLY fr APPLICATION ACCEPTED BY----------F 'C,0 -------------------------------------------------Z-------------- -DATE----- 7f, - REVIEWED. BY.- ,.; '` _ ---------- €------------ ------- --------- - ------- DATE,_----------------------------------------------------------- BUILDING PERMIT 1551IED L.- ----------------------------------- ---------- -------------- ------ ---"-----• DATE----- ---••--------------------------- ----------------•- Alter tions and/or recommen atio s:...:........... .__`____ �! Y --- r , . t. �- �7- 5� - -� C� i ---------� --------- ------------------- ------ ----------------------------'�----=------------=- ------------------ -------------------------- -=------- ------- ----------------------------------------�•---------------- '--' ----------------------- ------------------- ----------------------------------------- ------ ------ ----- FINAL INSPECTION BY:• `1 � ------_ Date ' kis � _ _ _- .__ _ S N JOAQUIN LOCAL HEALTH DISTRICT J I -•- 7 (;f t , µ 1 1601 E.Hazelton Ave. X300 .t'Oak stree_t i 124 Sycamore Street 205 West 9th Street �i Sad locktanr California Ls,California '�� Manteca,California Tracy, California ES 9 REVISED 8.59 3M 3-'63 F.P.M {