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FOR OFFICE USE: 13 � — "------ --------- APPLICATION FOR SANITATION PERMIT Permit No. _...__...--•---••-----• ------------------------- " -�C q-- ±'�f t ----------- r complete in Duplicated Date Issued _ s ------ -- - - This Permit Ex ires l Year From'Date .Issued t i - t ' n is hereby made to the San Joaquin Local Health Di&- - This G permit to construct and install the work herein escr� Applicalli Y application is made in compliance with County Ord ---•---•-- -- •- -- --- --- Phone--------------------•- JOB AQDRESSAND LOCATION.__ ----•--------------------- --------- _ ___-_e_________________ R ...... Owner's Name.__. - l nn -_ _ one__------ • ---------------- Address ------•• ---•- Address__.-----•- -------- -------- Ph t - -•- - -------------- ---------------- -=----- ------•- - Other �..y ----•----•--------- _ - Motel ❑ Contractor's Name_____- - �- - Traitor Court ❑ ` Apartment House❑ Commercial ❑ Installation will serve: Residence ❑ rp _ __ Lot size -.,�-+� - ----------------------------- J__ ------ ------ J_- Number of bedrooms t - Number of baths . Number of living units: De th to Water Table t� ft. Public system ❑ Community system Private ❑ p Cla Adobe Hardpan❑ Water Supply: ! Gravel ❑ Sandy Loam ❑ Clay Loam❑ Y ❑ New Construction: Yes ❑ No Wo-FHA/VA: Yes ❑ No Wo' Character of soil to a depth of 3 feet: Sand ❑ k Previous Application Made: (If yes date-------------- ) NO i TYPE OF INSTALLATION AND SPECIFICATIONS: { blic sewer is available within 200 fee#.) I (No septic tank'or cesspool permitted ip Distance from nearest well-____-------------Distance from foundation-------------------Material------------------------------------------------- Distance _-_____----ap city --------_--_:----: k Septic lank: ,� Liquid depth Capacity No. of -compartments---------------------------Size g 1 k ! �r�� •-�-____.Dkstance to nearest log line______. --_--•- "� Width of trench ` Disposal Field: Distance from nearest well___"` '-- Deng}h ofeach line ati �l • Number of lines_____ --- --- Total length____-- r*af ` --- \ - epth_of filter materia4__-_� V gg Type of filter matenaL - � } h pt L "` D'sstance o nearest lot line-4 See age R -___Distance fr m founds#ion___ V p pi}: Distance to nearest well------`-�---- • Size: Diameter-�+�y -.Dept -- Number of Pi --------------Lining material.__. � ✓ ®r . : Cesspool: Distance from nearest well-----------------D�tthCe from foundation--------------- Capacity__-_________--•-----•---•-gals. t ❑ Size: Diameter--------------------------------- p = Distance from nearest building ------------------------ ---- Distance from nearest well---------------------------- r - --------------------------------------------- Privy: ' --------- - AO. ❑ Distance to n©aresf lot line-------------- -------- --- ; ----- ---- ---------- Remodeling and/or repairing (describe):--------------------- ---- -------------- - ----- �__ -� F _ - _ .___*.�_.____ - _______________________________ __ __________________ _- ________________ ' _ ______________________________ -- --------- ------ ----�-"-•--------- ------�-- - � application and that the work will be done in accordance with San Joaquin County I hereby certify that 1 have prepared this app 3 1 ordinances, State laws, and rules' and regulations of the San Joaquin Local Health District{ or Cantractorl i ... ' --------------- '- W t f / e ' (Signed)--------------- 1. -------- [Titl } --- e _ By:. -•--•-------- -- --- (plot plan, showing size of lot, location of sys n relation to wells, uiidings, etc., can be place mon reverse side). FOR DEPARTMENT USE ONLY ` DATE------ ----- .. fr -------- . APPLICATION ACCEPTED BY------`-- '"' ' DATE ----•---------- -- "---- --------------------•------------• ---------- - REVIEWED BY------------------------------------- { ------ DAT . BUILDING PERMIT ISSUED------------ `- ------------:---------------=------------- ------- ---------=- -----------•----------- ------------ Alterations and/or recommendations:----- ------- ------- ___-_ •-----•-- -------- s i _. •------ -----•--•--- 4 ate.-:.---- FINAL INSPECTION` BY:._-- -' LTH DISTRICT - - - - -:`__ SAN .lOAQUIN LOCAL HEA 124 sycamore Street 205 West 9th street 300 West Oak Street 130 South American Street. -�, Manteca,California Tracy,California Stockton,California Lodi,California E6.9 REVIeEO e•79 rrP•o�'aM 6-60