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FOR OFFICE USE: 4, <br />........................... <br />.......................... _.-.......................APPLICATION FOR SANITATION PERMIT Permit No, 7-7 5 "S <br />............ .. . . . . ......... ­..................... � (Complete in Duplicate) Date Issued- - <br />.............. __ ...... This Permit Expires 1 Year from DO* Issued -7/140 <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work harain descnl3ed. <br />This application is made in cornAiance —ith County Ordice �'. <br />JOB ADDRESS AtMCAT <br />Owner's Name ....... ;? 444t._.,eev . . . .. . ............ .... Phone.— <br />................ <br />Contractor's Name..._.. ......... . ...................... . ««».....«..........._...__ Phons_._..__._ <br />Installation will serve: Residence 4 Apartment House 0 Commercial [3 Trailer Court 0 Motel [3 Other [I <br />Number of living units: 1_.-... Number of bedrooms Number of baths ..l'..._. Lot size ....4... . . .............. <br />Water Supply: Public system n Community system [3 Private � Depth to Water Table -7.0 ft. <br />Character of soil to a depth of 3 feet: Sand [] Gravel C] Sandy Loam J2 Clay Loam 0 Clay C3 Adobe [j Hardpan 0 <br />Previous Application Made: (if yes,date. ....... ... __-.) No X New Construction: Yes Q No [] FHA/VA. Yes ❑ NO 0 <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />4 <br />Septic Tank: Distance from nearest well,..........._.... Distance from foundation ...................w0swal._ .... ...... I—— ..... . . <br />0 No. of compartments .... _ .......... . . . ......... ._.. Liquid depth..........,."............. <br />Disposal Field: Distance from nearest well..).!;� .... Distance from foundation....:?:':' * .........Distance to nearest lot linell ....... <br />Number of Length of each line...J.9.0 Width of +rench.,311..­, ............... <br />materia <br />Type of filter Depth of filter material.1.7 _Total <br />00 <br />Seepage Pit- Distance to nearest well ......................Distance from foundation...__.Distante to nearest lot rine . ....... 0 <br />r_1 Number of pits.-_ ........ ....... Lining material ........ Diameter........_........_.._._ Depth__ ............. _ 0 <br />Cesspool: Distance from nearest well................. Distance from foundation....-.._.«,w—.„Lining ......... <br />nSize: . . ......... . . Depth ................. ....... __—_Liquid __gals. <br />Privy: Distance from nearest from nearest building_ ------- <br />0 Distance to nearest lot line._..... »_ .. ».w _ _ ...._w »..._................. ... <br />Remodeling and/or repairing <br />. ............ <br />........... . ...... . ........ ...... <br />............ ­­.­ . . . ................. .... «_... ............... ......... . . ........ . ............ ­­­­'­­ .. . ......... ...... <br />I hereby to `4y that I have prepared this application and that the work will be done in a=ordanca with San Joaquin County <br />ordinances. Sts laws, and miles arnd regulations r the San Joaquin Local Health District. <br />(Signed.......«............. Contractor)and/or <br />.......................................................».......... . ...... . . <br />(Plot plan, showing sin of lot, Rection of system in rolaflon to wells, buildings, ofc., can bre placed on reverse 444 <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY....................»..w.....»_............._. -- - <br />REVIEWEDBY . ......... . . .. __.- . . . ............ ............... . . ...... DATE........ <br />BUILDING PERMIT ISSUED......... DATE ................... ....... <br />Alterations and/or . . ......... . ... . . .................. <br />....... I ............................ �­ ........ ­­ . ...... ............ ... . <br />.................. ........ -.1'...- ............................................... <br />FINAL INSPECTION ..............................caw................... <br />SAN JOA(PUIN LOCAL HEALTH DISTRIX” <br />1601 1, Haxottan Avs. Wo Woo 04A stroat 124 Sy"mors Stroo 205 W*0 916 St#040 <br />st"kion, California k", California <br />96 9 MILVISIED 6-S9 MPA 3-'62 f.P.00. <br />6L <br />Manteca, California Tracy, California <br />