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APPLICATION FOR SANITATION PERMIT Permit No. (Comp��mv�te |n Duplicate), lete '—��` Dote |,me6 -../2� - � ' . ^ Application is hereby made to the San Joaquin Local Health Dist rict for to construct and install thwork herein described. Owner'sThis application is made in compliance with County Ordinance No. 549. qPiIQ 017 1 10-12 _ Name __ __. _,-__--___ ~-~.--^.-^----.. . .....---_---..__- ' ---_ _ - -7_-- _-�-''-__' -------------------------------------------------------------------------------------------------_------------------------ � Contractor's Name-, ------------ --------------------------------------------------------------------------------------------- ---------------- Phone---------------------------------- Installation will --__'_-__.'|mstallation "ill serve: Residence El Apartment House E] Commercial [] Trailer Court E] Motel [] Other �m ' ^17, Number ufliving units: _-- Number nfbedrooms -------- Number of 6u+6s -------- Lot size _.—_._—._-----.---- ` Wafer Supply: Public system El-Communify systeni Private R Depth to Water Table __ ft. Character of soil to w depth of 3 feet: Sand E] Gravel El Sandy Loam E] Clay Loam El Cloy El Adobe 0 Hardpan 0 � Previous Application Made: Ye, 0 Nu Z Now Construction: YesX No E] FHA/VA. Yes [] No �� TYPE OF INSTALLATION AND SPECIFICATIONS: / (Nn septic tank or'cwopon| permitted if pu6ii* sewer isavailable within 200 feet.) ' � Septic Tank: Distance from noon,,t w�U-��m-vr�.D�tice fnyn 6z i � No. of compartments Uqu�6 6epf6-'��----./��pu ° Dis | Field: Distance from nearest wvUA��A-4-.Distance from foun6afion-//o----------- to nuuu,,t |o+ |in~4---~'_- � Nomber of |in -.2--- '� of each |i�'��___W�� Typo of filter mafe�� fOWDnn+ of filter material -/-?°---------Total '-'--'_-_- Secpog; Pit: Distance to nourp, well----- ---------------Distance from foundation--------------------Distance +o nearest lot line,----- Numbero[ pits------- --------------Lining material----------------------- Diameter-----------------------Depfh--'-''�_�''��-- Cesspool: Distance from nenn,,f well-----------------Distance from foundation--------------------Lining material-------------- Size: Diameter--,--- ---- iamet c ''-''_-Dept _''''-_-'''-'��'-�--Uquid Copocit�_''-''-'__ga|c --- Or'ivy: Di�anoa from ~ pre,+��U-----------_--'Distance from nearest building -----_--'_. '_--171 Distance to nearest lot line'_'_-_''-_''---''-.-_.__.---__.-------'�-'''_-----''-''---- ' Remodeling and' or repairing (describe):--.-------.-'-_-_.___.--_--._�-____------_---.__._-_--__.- =� __--_-_'__-'_----_'---'' ''__.''--''--_-'__--'-_-'-_._---''__.-~-'-''''--'-_.''-'--.'-''-- ' ---------------------- --------------- ------------------------------------- --------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ -� | o ordinances, Local Health District. ' � .~� �� . ��n«dl''--''��l�—' ��..-�---_--_----'--_-_-_--._.�Ownarand/or <�ont�c|o� -- -_ By:------------------------------------------------------------------------------------------------------------------------------------`—le)---------------------------------------------- ------------' (Plot plan. showing size of lot, location of system in relation to ~ells. buildings, etc., can be :lamed on reverse sidm) . FOR DEPARTMENT USE ONLY REVIEWED8Y---.------.---.------------------.--------.----. DATE-----------_--_----_.- � BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----'_._--_.__.—.._____ Alterations and/or recommendations----------------------------- -------- ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------—'-'''-'''''-_.''--'''--'''-_.-'---'-__'----_''_---'_-.'---�� -------'—'-------'----'---------'---------------------------'--' ------------------------------------------------- -------------------------------------------------------------- ---------- �"� �� «�' FINAL INSPECTION 8Y� �- ..��. --.--. Do� .��' . �.^m--^.��.��- ---.-----''-� SANJOAQU|N LOCAL HEALTH DISTRICT 130 South A=°ac°" Street xvnWes+ Oak str"°+ mu sv="m"= St=.* uw North 'xr' Street .. Sf" kfo". California Lod'. California Manteca, California Tracy, California ss-q-2w . o".is°o 1'57 p.pzo.