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APSOCAT!ON FOR SANITATION PERMIT Permit No. ._..iV! s (Complete i Duplicate) �, d s 9 .�a�t. U / - z CJ Date Issued ._.. '�/`S•� Application is hereby made to the San Joaq✓�ocal Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ,Cora` A 7 JOB ADDRESS AND LOCATIO ...M.._.'..1!1L._.. .et.'_/:G°(�......0.......J��L[I�l ........�' f..Wc'o � l`d L�.__�U._._.... Owner's Name.........r -� �..e.aS----•- rn ........................................./ _--...-------._ ... _._�... Address................... � ........__. ..........� �....... P..h..o..n.e.�/y•-----�...-.-�---•-�--.-_... Contractor's Namh......F-lnv................................................................................... Phone 60.._.Ey.GO__.` ...r.. ' Installation will server Residence /Apartment House El Commercial C:] Trailer Court ❑ Motel Ll Other 04fix( Number of living unrts:.41*r. Number of bedrooms.r.. Number of bathe ..4_ Lot size ........................ j Water Supply: Public system ❑ Community system ❑ Private (Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Send [) Gravel E] Sandy Loam lay Loam❑ Clay❑ Adobe_, erdpen 0 ' Previous Application Made: Yes ❑ No 21" New Construction: Yes [F"No ❑ FHA/VA:Yes ❑ No❑ x TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weill.QC..'�.....Distance from foundetion_..�_ �......_MateVial.... .................�.: ..�.-•-"�.L.1 f❑� No. of compartments_.Z...................Size 's-�..3L•r••---•Liquid depth.. .r�/rCapauty_ \, Disposal Field: Distance from nearest well./ 4.' ...D."stanVf"rom foundation_.. .....Distance to nearest lot Iine_ _----------- 0-- 4_-----_❑- - Number of lines.........f........................Length of each line_......;.I 1r._:............Width of trench.......-fn................ Type of filter ma+erial4t4_14-n)' of filter ma+erial.._/J............otal length....... ...r.•..•--••• •-••• Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line C; ❑ Number of pits......................Lining material.......................Size: Diameter.......................Depth................ ... Cesspool: Distance from nearest well.................Distance from foundation.............._....Lining material.....__..._.......__ els � ❑ Size: Diameter.......................... ........Depth_.................._.:.:_....:..:..................Liquid Capacity................. g Privy: Distance from nearest well............._................................Distance from nearest building.......................................... ❑ Distance to nearest lot line.... ....._. ---••••-_••••••••••"'""""---"-""•" ............................ ...... /. Remodeling and/or repairing (doscribej: . .... ° -�?� ••.-• ---.•--. -.••, - --•--• --- .e n �.............. l <4�%ry/rte.... ttrr 4J...._ -- _.... __.. – ._..._._.._.__.. ......_.._......__ .................•••••••••••..._.__...__.- ...../�- ............................................... ..... _ ..._._ _ _ – _.._........................... ..................•----•---.......---..............-•-------_...•••••----•._._._._•._.--•-•- V1 1 hereby c rtif that 1 have prep r d this application that the work will be done in accordance with San Joaquin County ordinances, Sta la s, and rule and ulations of the Sin oaqui Loca eelth District. 1 on ec. ! .. ........ ............. ;.. /`J . _d.� tor) 1 (Signed). /V w. .. ... -. !.. f✓ li .- --(Title. _.. By:............. ._..._.... ....,,�........ I Plot plan, showing size of lot, location of system in relatiop o wel s, buildings, o., can be aced on reverse side). ( FOR DFPA TMENT USE ONLY ' i �— r•: _..... DATE.�---................................................ APPLICATION ACCEPTED B'i.. ...N-._.......-•........................... _ DATE._5`._.._._.__._._......._._........ REVIEWED BY.................................,.�...�...-�.................................... ........,........-•-......._.......... .� .................................._...._._..........._.................. DATE__._..S'r-...._........._........._....._......_.... BUILDING PERMIT ISSUED.........._ _. . . !7= ......... •-••••.............•_ _-......_.....••_•.`-.....__._........_.._.._.._... .._..._.._... .........................................._---•••- Alterations and/or recommendations:....-......_ .--_••--..•••••_--••••••-•.••-••--•_--•••-_---__..... _............. ........... ..... FI^:AL INSPECTION BY:..4in!" SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wt Oat Street 132 Sycamore Street 814 North "C" Street es 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California c1,_9_2\� 3evise0 i•57 F 0 CO_ -