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APPLICATION FOR SANITATION PERMIT PermitNu - � Duplicate)w _ (Complete_ _ Dutm |soum6 -I/x��'�� /\ o|ical-ion is'herebv made to the Sun Joaquin Local Health District for 6 permit to construct and install described- This application is made in compliance with County Ord inunco No. 549. ,------ Contractor's Name----------------------------- ._--------.-_-_--_---�-__-_- Phone----------------------------------- |�� will ^Residence % Apartment House E3 Commercial [I Trailer Court Ej Motel E] Other Number ofliving 1r|'^' ~ � Number of bedrooms 3- Number ofbaths Lot size �~. . _- ---_-- ' / _ Water Supply: Public system � Co m�� 'system Privafeg Depth to Water Table -------- ft. ~ Character of soil to a depth of 3 feet: `Sand E] Gravel El Sandy Loa� El Clay Loam 13 Clay [] Adobe[] Hardpan is ^ Previous Application Made. Yes No �� New Construction: Yo, �� No [1 TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic PEC|PiCAT|ONSM4mvmpfic tank or cesspool permitted Septic Tank: Distance from neo,esi wuU1b6i.:-----Distance from foundation---11L---------Material ..��.��.�v�..�~~__ 5d No. of comp*rt'ronb.r2 --- ------------Liquid 6aAfk------._`Co 'odty-------`-------------- Disposal '____Dispos | Field: Distance from nearest -well- ~66"Ib Dis ~ vo from foundation_`J,-P-~..-.D|sfnnm, to nearest lot line �'..^_. Num6er of | ne, ��°� Length of each |ino-_��A.�-._—W�t ofhmn�h—..�,� .�-__._ Tvoa of �ha - ' .-Deo+ of fUh,, m^+��L-.��..',------Total length-------ZAP.7-_______ Soapugo Pit: Distance to nearest, ....-._ �.^ ..^� -_Distance to ^ |i�� ./ / -- Number of ^-��-�Lining mate^ �a : D� '-'' 'pfh� ��-.'' -'- ^ ` " U ` / Cesspool: Distance6om neon*� wp|L--._-Di�anoafrom foundation--------------------Lining material -_--' ------------------- [] Size. Diomo+er ----------------------------------- Depth'_'''_��'--''-'''�'-'-Liquid Capacity----------------------------gals. Privy: D�sfance from nearest °e|L-r------.----.- ---Distance from neon,o+ building'�__-'_.____.� � �] D�+onoofonooret �t |�o-'''�''^'�-��-''-��.--__-___--'-_________________.________ Remo6=ing and/or ,npo|6ng (describe):------:---------------------------_1------------- ----------------------------------------------------------------------------------------------- ------------------------------- ._._.__'_. _..___--_________.__._�__._.___________________.____. \ ` -_.-----_-_-^.'---.,'----_' -._---....'--------_--_.-----.----------------_--_-.-'--...----_----_-- --.-_-._._-..�-'__'--_---__�__._�-__'---_-__.-�-.__---_.___'—_--___-----_-'—_- I hereby certify that I have prepared this application and the+ the work will-6e done in accordance with San Joaquin County ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------/_ ;, py�'--'''--'----'-----'-��-''--''�-.'-''_'-_--�'-_'-_.'--(|��_________._____________-' /Plot plan, showing size of lot location mfoy»t,m in relation to me|ls. 6uUd|ngo, otc, can he placed on reverse sYdmJ' _ 41 FOR DEPARTMENT USE ONLY ------------------ ------------------------------ --------------._ -------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------- ---------------------------'--------------''-''-'-'''-''-'''--_'-'-'''----'''-'''--''------------------------------------------------------------------------ --------------------------------------------------------------------------- -_---._--.___-._---_---.-__'_-__—_—._—.. _-'----'—''-_-'-''' -------------------- _'-'''-'''-'''-'''-'''--'--------------------------------------------------------- FINAL --'''-'--'-''--'-_'- FINAL INSPECTION BY:-----... --------------------- �Oute _4---------------------- ___________~_____ SAJN JCAQU|N LOCAL HEALTH DISTRICT /ou South w"°ric°" ytr°°» 300 West Oak Street /s» Sycamore s*re°+ 8/4 North "C" Street u+"ckt"". California Loa|, California w°"+°= California Tracy, California