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FOR OFFICE USE: �r APPLICATION FOR SANITATION PERMIT Permit No. ._I. .6_V-6_.. ---------- (Complete in Duplicate) Date Issued Z__/�__6-V ------------------------------_-_.--. This Permit Expires I 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, r P 3 P IR J B ADDRESS AND OCATION r�11-1- =�+1�-�'Y1l `'j �'Ve diU�__sl t Q_�1[Mt� , --------- Phone------------------------------------ Owners Name-------- -�-------------------------Br-1.0. -------------'--- ---...---------- ------------- ----------------------- ----- • ---•----------------- ---------•-----------------•-•---- Address_ ---- -------• ---- -------- ---------------------•------ Phone------------------- ------- --- Contractor s Name -------------------------- Installation -------------- •---- - Installation will serve: Residence VApartment Housev❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ .1_ Number of bedrooms _ ___ .Number of baths _+ ___ Lo+ size __- _` --------------- Water Supply: Public,,system ❑ Community system ❑ Private 0j/lSepth to Water Table 7 ft. E Character of soil t7! a depth of 3 feet: Sand I] .Gravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ w Previous Application MA : llf.yes,date__.____ _ ._ _.___). No �ew Construction: Yes" ❑ FHA/VA: Yes [r�o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: s _ (No septic.tank or cesspool permitted if public sewer Is available within 200 feet.), Septic nk: Distance from nearest well�________Distance from foundation__,�R_ -- _.Material-__ 1 No of com artments.-._ _'_-_-.-_ p ,� Size-,:5" / , Q---Liquid depth__' -------------Capacity-k ----- • :3 Dis osaI field: Distance=from nearest well-v .. .-Distance from foundation__--'`-_-__.Distance to nearest lot line-45l _._______- p Nufnbeir of lines____ l--------------- Length of each line-_' ��_ / -Width of french--- -------------------- ------- 1 T "e o f ter era ,De thTof.yfilter-material____ Total length_ -�______________ �'-- p / 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 founaatian------------------- Lining material___.--_-.--___-.-_--___-___________ Size: Diameter---`---------- -------------Depth_------ -------------- ----Liquid Capacity----------- gals. E ; Distance from nearest building i Distance from nearest well------------------------------------------- ------------------------------------------ Privy- ❑ Distance to'nearest lot line - ---------------------------------------------------- -rz'"4 - ------------------- - . t'f Remodeling and/or repairing describe _. , 5 j---------------------•--------------------------------------------- ---------•- 9 / P g ( )=-------------- 1 ------------ --------------------------------------------- ---------------------------------------------------------------- ----- ------------ s I hereby certify that I have prepared this applicatiA and-tha+-the-work will be done in accordance with San Joaquin County ordinances, State laws, and rut and regulations of the San Joaquin Local Health District. (Signedi ---------- ----------------- -- Owner and/or Contractor -------------- -- - d -- I 't, y:--------------------- - (T fle (Plot plan, showing size of lot, location of system 1 relation to wells, buildings, etc., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY i �-G-��'�----------------------------- APPLICATION ACCEPTED BY------ --- =---------------------------- - --- DATE-------- REVIEWEDBY------------------------------------- - ---- -- DATE-------- --------------------------------------------------- BUILDING PERMIT ISSUED - ------------- -DATE----- -------------------------------------------- ------ i Alterations and/or recommendations:--------l_��_J� -- Ge-cr.. _ � - •~ �� '{= ( ------------ --------------- ---------------- --------•-• ---------- ----- ------ Date ------ ------------------- FINAL INSPECTION BY--------------- ---------- SS - --rNJOAQUIN ---------- - -------- LOCAL HEALTH DISTRICT 1601 E.Ha:eltan Ave. 3Street 124 Sycamore Street 205 West 9th Street , rnia • :+� '- Manteca,California Tracy,California Stockton,California � , F.P.0 13.