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FOR OFFICE USE: y -- ----.- APPLICATION FOR SANITATION PERMIT Permit No �Jr... _ .. -------- 7.. . ...................:.... in Duplicate) /�.ZT / _ (Complete P ) Date Issued ...............(a3 • This Permit Expires 1 Year From Dat'11sued Applicationis hereby made to the San Joaquin Local Health District for a permi to cons ct d install t r rein te acrl ed. 1- ,4 T is a lice ion is made in compliance with County Ordinance No. S-kl49; dOB ADDRESS AND;LOC ON........-._...... ... .�1 - �/ -. ... -.,......-....N ...-....... - - �....�. d�'�- ......................... . .-.... Phone..---...----------------------- Owner's Name........ ... ..... ........... - - ..... s -- -.....I................._. .......-- -... -- _._._ _.- Address...-.........s�r..Q..-- ------ - Contractor's Name..,0114�- ---------------------------------------------------------------------I----- ------.................... Phone................................ Installation will serve: Residencea Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J..... Number of bedrooms ........ Number of baths -------- Lot size ...................................................... Water Supply: Public system ❑ Community system ❑ Private go Depth To Water Table 19- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date... ) No Pq New Construction: Yes W No ❑ FHA/VA: Yes❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �.(No septic#ank or.cesspool-permitted if-pubric sewer is-available.within,200Teet.) -- -- y�r- -T Sept�ijc Tank: Distance from nearest well-a i0---------Distanc fro foundation_-/.-fll_�........Material.... ...... 4-------•--- No. of compartments-.-_ ..-..-----. ..Size-:y t. ...}! ...:.....Ligwd depth...... ..............Ca a s... - f , Disposal Field: Distance from nearest•well_e�O.........Distance from foundation. Disposal to nearest lot I`ne_s�.._-...._.... Number of lines---_�-- `.---- -. y Length of each line..4.0.:..................Width of french.....�r .'................... Type of filter materilfiS Depth of filter material..-.._-/. .'..-:...Total length...�' ?�.---•----------- - Seepage Pit: Distance to nearest well ------------ --------Distance from foundation.._..-.-_..__.__.Distance to nearest lot line----------------- ❑ Number of pits.....................Lining mate rial-------- ------------Size: Diameter--------___-----....Depth-----------------..._.._....• •Cesspool: Distance from nearest well.................Distance from foundation....................Lining material....... ❑ _-Liquid Capacity...- ----g Size: Diameter--------------------------------------Depth_..------- ------- - - -- ' t Privy: Distance from nearest well------------.._--_--------- -_..........-Distance from nearest building---------------------------------------... ❑ Distance to nearest lot line-------------------------------- ...--'------�-----------------------I—............ ........... -------.........................__...._.,..._-...... --._..-.......:.............. Remodeling and/or repairing describe .......__..................................................._.... ......... x .....................----- ------...... --Q>k ---------------- ----... I herebyy certify I have prepared th's application and that the work will be done in accordance with San Joaquin County '\ ordinances. Stets S. d rules pnd reg 'ons of that Sen Joaquin Local Health District. ...........................................(Owner an._d./—or Contractor) (Si nestle .........__...... (Plot plan, showing ime of lot, location of system in relation to walk, buildings, ata, can be placed on reverse gide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPT Y N. DATE.....L.�j -`- .....--.....-----------_-- APPLICATION -----_- ,g DATE .................................. REVIEWED BY--------:.�r✓�/�......................................................... - - - ...... - BUILDINGPERMIT ISSUED----------------------...-_............................._..........-.................--...... DATE------..-....__... ----- . ... ---- ' Alterations and/or recommendations:-__............._----_-.-- --------...--------------------------------- - - -..._............................................. ........................................................................................................ ....................... ... _.......... ......... - _..........-- '--..................----------------- _ ....................................................._....-...-..._---. ........,..--...._..I..................................................... -......................-...... rr • -. oo ---� /�. p / ........ FINAL INSPECTION ..'-(- - Date--...C-.'- - .J........................__............ `SAN JOAQUIN LOCAL HEALTH DISTRICT ` t6:. 205 West 916 Sweet 130 South Amerlaan Scree} 300 WaafaaY Sweet 124 SYwmon Street lodL California Manteca,colif a tela Tracy,CaliforniaStednan,California .,