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Application <br />This application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br />is made in compliance with County Ordinance No. 549. <br /> <br />FOR OFFICE USE: <br /> <br /> <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />This Permit Expires 1 Year From Date Issued <br />Permit No. <br />Date Issued Issued 1/.---‘ —Z7 <br /> <br />JOB ADDRESS AM <br />Owner's Name.... ..... <br />Address <br />Contractor's Name <br />Installation will serve: <br />LOC TIONe49„, acee.A: <br />Phone <br />0 Trailer Court U Motel 0 Other Er' 49'r <br />Number of living units: _. Number of bedrooms Numbeyf baths Lot size <br />Water Supply: Public system 0 Community system 0 Private f Depth to Water Table ft <br />Character of soil to a depth of 3 feet. Sand 0 Gravel 0 Sandy Loam 0 Clay Loam 0 Clay 0 Adobe 0 Hardpan <br />Previous Application Made: (If yes, date I No 0 New Construction: Yes LI No FHA/VA: Yes D No 0 <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septic Tank: Distance from nearest well 't Distance from foundation Material <br />0 • <br />Distance from nearest well ....10----/. Distance from foundation /V ' Distance to nearest lot line ..r T <br />/ <br />Number of lines,N, ........... .......... L__',..._.__ Length of each line '''IP Width of trench 2 - <br />Type of filte; Material <br />... <br />C, g 7 jDopth of filter I material.. .i.f b Total length ,i..f..2 ' --, (\A <br />Distance to -nearest well. .../.& i• "Distance from foundation ./V T Distance to nekest lot line -r / (j ., ,..).. Number of orts. .1 . Lining Material SiZ • Size: Diameter , ... 33 i' Deth -247 T NI . ..... ru 1 . 3 <br />'Size: Diameter.. rest \kit 4 .....-.....- DIStanCe from neares well .' Distance from foundation Lining material •-, <br />--...•• ,Depth <br /> Liquid Capaciiy 4. ; gals. <br />Distzinee—from nearest well—i Distance from nearest building I .. <br />, <br />I I . <br />I hereby certify that I have prepared this application and that the work will be done in accordance with SarJoaquin County _ ordinances, State laws, a rules and regulations of the San Joaquin Local Health District, ....--= _ <br /> Ti1T----..and/or Contractor) <br /> (Title) <br />relation to wells, buildings, etc., can be placed on revers i side). I <br /> Phone <br />Residence D Apartment House 0 Commercial <br />No. of compartments Size Liquid depth ...............Capacity <br />Seeloa,g,i Pit: <br />Cesspool: <br />LI <br />LI Distan'ce-f&-q.7gresflOt'line <br />I t <br />Remodeling and/or repairine(Ciescribe)• <br /> <br />4-ee-erf <br />(Signed) <br /> <br />By <br />(Plot plan, showing size of lot, location of system in <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY..... DATE.//"..q? -67 <br />REVIEWED BY DATE 1 <br />BUILDING PERMIT ISSUED DATE <br />Alterations and/or recommendations. 1 <br />FINAL INSPECTION BY:. <br />1601 C. Hazleton Ave. <br />C.alifornia <br />EH. 9 2M 1-67 Vanguard Prinz <br />1 f <br />• <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />300 Wee Oak Street 124 Sycamore Street <br />to& California Manteca, California <br />205 West 9th Street <br />-F1Tracy, California <br />