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APPLICATION FOR SANITATION PERMIT Permit No.01.2--f-3_ (Complete in Duplicate) Date Issued �S err Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wgrk herein described. This application is made in complianca,wit County Ordinance No. 549. JOB ADDRESS AND L ATIONi .....:../X OwnerNs eme _ .... .. ..... ..... .. ......Addrsu.. _ ........................................ _.._....... ... Phone................. ........ _......_.....___. Contractor's Na L .... .. . .!�� l''. ..A-,.' � �P+l.4h�_... Phon4m.:-�._7_7131. Ir►staAa4ion Mn'M serve: Residence Apartment Houseommerciel ❑ Trail Court ❑ Motel ❑ Other Number of living units: __./... Number of bedrooms .�-. Number of baths 1..r'/Lot size _f_.11.U..._./�_.l._AJ_t/ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table ...__.- ft. Chw*chw of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam[.Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ Preview Application Mad*: Yes ❑ No Q� New Construction: Yes 0?1** No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cosspool permitted if publiicrs "r is available within 200 feet.) Sep enk: Distance from nearest well. 5II.4.Distafcegrom founds ion.. . ....... .Met lel...." :....... No. of compartments..... .-�_....Size...<1....X..+ .X-Liquid d�prh....... .... ..... Capacity.... �,... �� ., DispospI Field: Distance from nearest well.. . . ..Distance from foundation. _ y. ..... � Distance to nearest lot line . `�r.......... Number of lines..........�.'�•� ...I Length of each line.......... rr.....Width of trench.........!.. .. Type of filter ma+eriatrf '.i. _'J^depth of filter material.......�..(�).._.....Total length....... .......... Seepage Pit: Distance to .9erest well..... ......._..... .Distance from foundation..............._..Distance to nearest lot line................. ❑ Number of pits ...... ............Lining materiel...- . ....... ... .. Sae: Diameter.......................Depth................................. Cesspool: Distance from nearest well........ ........Distance from foundation ...........Lining material. ................................... ❑ Size: Diameter...... ... _ _.Depth Depth............. .....................................Liquid Capacity.........................._gals. Privy- Distarce from nearest well. ... ... ... .. ................. .... .....Distance from nearest building..... ................................... ❑ Distance to nearest lot line... ......... . r'-- Remodeling and/or gepair"in)gg (de'sscgtihe):w..............��.X..4...�.. .................. .....,. ...............,...................................I......-•--...._......,.... �--_L7_-Sy......._'^rw """""'V".e—A..-.0..:n:�r:.�_.��`....y.�i'_f<��.!-SvS «...... ...-j*---...�...Y.,.�....... ........ .1I.»........�...,._�...'..C•_..•�- -f ....................l. .i.... ; . ....------.................................._............................... ---......---•-•-------• ---•-•-----•..................---..............._............-•----•--•......................................... . I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, tate laws, and rules and regulations of the San Joaquin Local Health District. (Signed)............ wn...'....�_r..r,!. ... `.C::--- :.�.` +.� Com... - _ (Owner and/or Contracto By:...................................................... . . .. .._. . _ _ (Title) - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. �� ..... DATE-s-- REVIEWED ATES REVIEWED BY_. _.. . _ �� 1 DATE.. 7�� ..... _.. ...... ...... . BUILDING PERMIT ISSUED. . ........ . `. _ DATE. ,�.. Alterations and/or recommendations:. r:Al I.l;PKTIOBY ,,�--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South ATer;ein Street 300 Wwrt oat Street 132 Sycamore Street 814 Nor11• '•C• Street Stoc140n, C014orn4 LoJ;, Cakforn;e Manteca. cafforrf• Tracy, Calilorn;e