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FOR OF'ICE USE: r .r..l<.�:.,G... . .............j`:.. APPLICATION FOR SANITATION PERMIT Permit No. -----• ................ ................... . . .. ......... (Complete in Duplicate) a� `��` • - This Permit 7 Y -Expires Year from Date Ise Issued sued Dat _ ApplicatiGn is hereby made to the Son Joaquin Local Health Dixirict for a permit to construct and install the work herein describe^.. �: g; _ This application is made in compliance with County Ordinance No. S49. h�•� ' >- t JOB ADDRESS AND LOCATION.............. �-Q..X�`��. �/i1�1.C'✓�-r. �� Q�Y�.%S�1's�i4'�. Owner's Name... 0 ..... V ............... .. Phone.............. r S Address........... t ................................................ Contractor's Name......... r-•� .-.-......-.. ..-................. -- ...._................--..................... Q qr a - Installation will serve: Residence SL Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other L7 ,. ' Y, Number of living units: ...-... Number of bedrooms-,3-- Number of baths -...f. Lot size .....mc - . .. ........ v •e ��., y:r. •,ir., xt. I]��rt f, Water Supply: Public system ❑ Community system rr ?:Ka 'r. y y ❑ Private ( Depth to Water Tab ........ ft. �-4r $ *<�Iir 1 Character of soil to a depth of 3 feet: Sand CK Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ 'Adobe❑ Hardpan 0-1 � r ',x Previous Applicafion Made: (If yes,date.,....... ......... ) No ( New Construction: Yes [2�,No ❑, FHA/VA: Yes ❑ No❑ &Z �- k r:Sw 'st TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) z7s b 1 Se ti Tank: Distance from nearest well- �' Material..... . •----........ F.� � .f�� Distance from foundotion... - � I No. of compartments..... .. ....--Size................. O •-•--. Liquid dep.t.h...--.-.................. .......... Capacity ap.1a.,.c�a.i+t+y.� Disposal Field: Dstance from nearest ... S ...Distance from foundation....--.- -/.-.Distance to'nearest lot l:i..n,�..e� iNumber of lines.......... ...Length of each line--------------- D.r...Width of french----.. .D.�+7v•rs r: r type of filter material- of filter material._.---.1-- length71 i Y it { P -------Total ---•... /8QE r F Seepage Pit: Distance to nearest well...................D;siance from foundation....................Distance to nearest lot line Y% 8 ❑ Number of pits........ ....... ..Lining material.................--Size: Diameter......:................ F t Cesspool: Distance from nearest well................Distance from foundation --....Lining material--...................... ❑• Size: Diameter. .............. Depth--------.......,..................-...... .......Liquid Capacity- gals Y r Privy: Distance r rem nearest well..............................................Distance from nearest building. w.� a� ti 4 ❑ Distance to nearest lot line....-.. II -... ,�.., Remodeling and/or repairing (describe)........... .............- •- .......................................................................................... � t�' n i }r I hereby certify that I have prepared This application and that the work will be done in accordance with San Joaquin Counfy r; i ( ordinances, State laws, and rules and re ulafions of the San Joaquin Local Health District. t Ak . i � r rr ................................-...................-.-................... ...... Owner and/or/ r d o C onfractor fit (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__......................... ... .... Ll.... ...�� DATE............ .�'. .l� fy=}ti4 ! REVIEWED-BY.:...................................... .. ....--............ . i. ......................................-..-. DATE............. BUILDING PERMIT !$SUED. ----------------- ------ ......-.. --............... DATE..... ......... .....--....:..... - • '_ a(F'" ' o- -� Alterations and/or recommendations------ --------- ............,.......... .......................................................................... -----••---........ ................................................ ...... .............-.....................................-.-............................ ' > . Y. {j ) ........................ . ............ .... . ----'..................."'.--`--...... ..__...............-------'-'--...........--------•-""'-.................................------......-_...-.................-- 'nr s "" FINAL INSPECTION ... ...... . i r ................ s.- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 1:.Hoxelton Ave. 300 Wert Oak Street 124 Sycamore Street 205 Wap 9th shnT iadi.C.UO-10 Manteca,California - Stockton,California -t *•T»'�;�� - Tracy,Califarnla - 2. I r• � �a a