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F R.OFFICE USE: c.-----------� --------- APPLICATION FOR SANITAT-iON PERMIT Permit No. .-��p-- ------ -------------------------------------------------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a �ca+i�is m de in oi�p' nce with.Gau di ante No. 5 JOB ADDRESS AND CATI N__f�- . _ - ... -- -- -----Vii'...------- ----------------- Owner's Name-------7 -•- • � 1---f- •-------•--•----• ._ ne - ~ — •---- ...... Address_--•-------------------- --•- a �i- = ��-_ --------- V =' ------------------------ Phone.---.....-_-------•-------------- Confractor s Name---- +� ------------- ---- Installation will serve: Residence � artment Hou l"❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ p Number of living u Z-- Number of bedrooms—3_._ Number of baths):_____ Lot size ___/ �-- �--` Water Supply: Public system Community -sys;am ,❑ Private E] Depth to Water Table. .��ft. Character of soil to a depth of 3 feet: 'Sand ❑ Gravel,❑ Sa Loam ❑ Clay Loam ❑ lay ❑ Adobe Hardpan [] Previous Application Made: [If yes,date_________________._) Nom New Construction: Yes No ❑ FHANA: Yes ❑ No ®� PP _ r TYPE OF INSTALLATION AND SPECIFICATIONS: e'[No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic n ' Distance from nearest well Distan a from foundation____//..._._.Mat�ial___ _-_:._____?-/----e____________________ No. of compartments- .__Z -------------Size--�- -- -- -- ------Liquid depth---- -��_------Capacity.-.- --_f�� s Disposak 'eld: Distance from nearest well__—� - ..--Distance from foundation4_ __ 4______--__Distance to nearest lot line____...._ Number of lines_____ ____________________Length of each line____. - : idth of trench_-�=- _ .'�_______________ Depth of filter material_-- ��____----.Total length____ K_V:V_/_____________________ .Type of filter matenal_-- ��._.______-_-- p ,�-- / SeeDistance to nearest.well__,e�ga---------Distance from foundation__/_6___ Distance to nearest lot line-- ---------- Tn Number of pits._.._Z_y--------Lining Size: Diameter-__-.3 3__9__--_Depth�.��r�'"gj� Cesspool: Distance from nearest well-------------- ._Distance from foundation-------------'-----Lining material-_____________________________________ C ❑ Size: Diameter------------------------------ -------Depth---------------------------------------------------Liquid Capacity---------------------------gals. G ¢--- �--r [}stance from nearest buildin ______________.._ --- Privy: Distance from nearest well----------------------------------- - -- -- - g------------- ----- ❑ Distance to nearest lot line--------------- -----------•--------------------------------------------•----------------------- f Remodeling•land/or repairing (descriUe): -( $ wL-'lf 4 ��--� ----------- - - ---------- -- - ------------------------------------ -------------------------------------------------------------- ----------------------•---------I.-._......---------------------------------------------------------------------------- ----- - - - ---- -- --- - ----- ------------•-- ----:----------:___-- -:::-:----:.-:-r:•:------------ --:---- _-----=----------------- ---------------------------- k I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County , ordinances, St and ru and regulations of the San Joaquin Local Health District. Owner and/or Contractor (Signed..-----•---- ------ (Signed)..- ---------------------------------- ----- -------------- - - -------------------------------- ----------------------- ---------------(Owneri 4 By------------------- ------------- {Title) �, -- - (Plot plan, showing size of ation of system in-.relation_to ......1s,;buildings, etc., can.,be placed on reverse side).. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --- -- - -- � �-------------------------------------- DATE---f! ------1_1 ----------------- REVIEWEDBY------------------------ ----- d ----------------- -- ------------------- ------------- DATE--------------_--------------------------------------------- BUILDINGPERMIT ISSUED------------------------- - --------------------------------------------------- DATE-------------------------------------------------------- --- Alterations and/or recommendatins:------ --- ------ �-----•- ------------------------ •----••--------- ----------- I ------------------------------------- ------------ ------------------------------------------ ----------- ---------- ----------------------- ------------------- - ------------------- ----- . --•------------------ ------------------------------------------ FINAL ------- -:------------------------FINAL INSPECTION BY:----- -fWest � Date----------- 1 F'= ------------------------------- 4 OAQUIN,LOCAL HEALTH DISTRICT , 1401 E.Haxelton Ave. ak Street, 124 SycamoreStreet 205 West9th Street fornia a' Manteca,California Tracy,California Stockton,California / f ES 9 REWSED 8-59 3M 3-'63 F,MCD.