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FOR OFFICE USE: J, - _-_!3 �' ----------------- J Permit No. .221E------ Y �" APPLICATION f�OR SANITATION PERMIT . --------- -------- --------- - ;M _______ (Complete in Duplicated Date Issued f �IM This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Health District for a permit to constr ct and install the work herein described. This application is made in.' compliance with County Ordina ce No. 549. I JOB ADDRESS LOCATION ---I--- -- ------------ t .i` --------------------------------------- -------------- - Phone------------------------------------ OOwner's ----------------- wner s Name------ - ----- ---- -- - ----------------•----------�---------- --------- --- r __ __________ Address------ ------ ----------------------- - Ph I I� r - one...- S '. = Contractor's Name.------ - - --------•- -------- --- . Motel Other ❑ ✓ ' Installation will serve: Residence [E`--Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ Number of living units: --- Number of bedrooms __3__ Number.of baths -1----- Lot.size ___./7_d_ �1-Q-----•--------------------- j Private ❑ Depth to Water Table __w-Pift. I, Water Supply: Public Sys [Community system ❑ Character of soil11 Fl Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay -] Adobe L1 r�ard to adepth of 3 feet: Sand FHA/VA: Yes No 1 k ❑ Previous Application Made: (If yes,date____________________) No k' New Construction: Yes [� No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- ry (Na septic tank or;�cesspool permitted if public sewer is availablts-within 200 feet` f a�, ' --�----- -- Septic Tank: Dista ice from Nearest well________--------Distance from foundation ft?____________.MaterlaL(---_____-_...__.._.__ OD� c� Li uid de th - . --------Capacity No. of compartments__ --r--------..-.Slze__�_XC�_-x_ -----•- - g #f n Disposal Field: Distal�ce from nearest-well_._.--__.____-_Distance from foundation_/k__f___-__._.Distance to nearest lot I`ne_ -�,----. ` ten th of each line___7 --------t__'__Width of trench_- --:------ - '" dumber of lines___i___ _ g .. I � � Type�of filter mat#real_•_ _ -ft- h-- ---Depth..of filter material__[$._______+.__._Total kength__ -- -- ------- --•------.F! � ..- .. Seepage Pit: Distance to nearest well_.___________.___Distan�ce�from foundation_f�______________.Distance to nearest lot line_.I__.,:__-:_... ❑''� Number of pits:--- �---- ------Lining ma`erial_-/[-.c�.f. ----.Size: Diameter--- ft--r�----------Depth----��cS' ��----.------ Cesspool: Distance from nearest well_________________Distance from foundation._.__.____._'_.___.Lining material------------------------------------- y. ❑ JV Si ie� Diameter----- ------------------ -----------Depth------------- ---------------- -------------- Liquid Capacity gals. ( _ ---____---_Distance from nearest building Privy: Distance from nearest well________________ __ t ❑ Distance to nearest..lot.line- - ----------------------- 1 �II. . — Remodeling and/or repalring (describe)--------------- -------------i----------------•------------------------------- ----------- ----------------- ----------------------------- -------------- ! e il. -------------- ----------------------\ -----------------------•-------------- , -----�-------------- -------------- ---------------- ----- ____________________________ __'L_____ ___________ __________________________________________ I c I hereby certify that I have prepared this appliation and that the work will be done`in accordance with San Joaquin oun y joe ordinances. State laws, 'and rule's nd're ulations'of�the San Joaquin Local Health District. LQ C r79 I (B�trwer-aador ontractorl St ned - 9 )-•--------------- - - ------------------- -------(Title [Plot plan, showing size' f lo+, location of system in relation to wells, buildings, etc., can be'placed on reverse side). I i FOR DEPARTMENT USE ONLY t ------------ DATE- APPLICATION ATE APPLICATION ACCEPTED BY° _ DATE- I REVIEWED BY---------------------------#-- - ; - - AyamTE--------------------- f----- ---�-----�--r--- BUILDING PERMIT ISSUED ------ -�---------�-------- c`�---z- ----r-1-. -- ---_------- ---- - ' -'-2. =- Alterations and/or ricommendatons:-7'-- ------------------------- ------ - ------------------------------------ _ s, '----------- ------------------- -------- _______________________ _____________ k- -- - .. --------------- --•---------- ---------------- / � ate - - TION BY:_ - ----------------- -•- „ FINAL INSPECSAN JOAQLkIN LOCAL HEALTH DISTRICT 30D West Oak Street 124 sycamore Street 205,Wesl:-9th Street 1601 E.Ha:eltan Ave. • .1 II 'Manteca,California ...�{::�'s-',"7ra[y,California Stockton,California Lodi,California ,r:A,• A,. I41N C5 9 FMVISM3 8-59 3M I�3-'63 F.P.CO.