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rk <br /> APPUCATION FOR SANITATION PERMIT Permit <br /> (Complete In Dupficafb) <br /> Data <br /> Application is ioroby ma-+e to the San JoacIL417Local Health District for a permit io construct and install the work herein described. <br /> This application ;s made in cornplianco with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCCATIOIJ,- ....... <br /> Qwnor's Name ......(:-Iclh I rl..s.... ........ . .. ..... Pnono-aN..... <br /> Address.. ...................-....... ... ....... ....... .......................- ......................................... <br /> .. <br /> Coniractor's Name......... ...... ..................... ...... ......... . ......-.... phone C, 0-7.--- <br /> installation will serve; Residence /Apartmenf House [I CoCommercialC] Trailer Court [I Moto] 0 Other D-41-ftx k:-- <br /> 9� <br /> Number of living ,it., .-lr. Number of bedrooms .7r7.. Number of baths -4- Lot size -J ....-......... <br /> Water Supply. Public system [3 Community system 0 Pr;Va'Ie Depth to Water Table -....- ft. <br /> Character of soil to a depth of 3 feet. Sand Gravel [] Sandy Loam P-1c"lay Loom C) Clay E) Acloba.r �Hardpar) 0 <br /> Previous Application Made: YGi [_1 No 2 Now Construction: Yes ff' No E] FHA/VA: Yes E—j No 1E1 <br /> TYPE OF INSTALLATION AND SPECII FICATIONS: <br /> (No septic tank or cosspool Permitled if public sewer is avedablo within 200 foot.) <br /> .. ........ <br /> jopt'c Tank: Distance from ncizres- wr--Il1.00.."--D;sfancn from M.te, ........-.5 <br /> No, of compartrner is' -v,(...3z.........Liquid Size.- depth-,,i. .,.r: <br /> F;old: Distance from nenrost well DTnk from to nearest lot ......... <br /> Number of lines........ .. <br /> ... ........Length of each line..... ...Width of ........ <br /> Type of -,ilior mate ...Dcpt}i of filter material.... langth-.... ........I........... <br /> Pit: Distance io nearest well ........ Distanco,from fowndat ion......... ......Dltsf6nce to nearest to' lino...,...---....... <br /> Nurrber of p;ts..... .. ... ........Lining material...:...:...... S; e: Diameter.......... .. ...-.-Depik............ ............. <br /> Cesspool; Distance f+-orn rearost %YO.................Distance from foundation. —...........Lining matoridl............................. <br /> --1 ........ ......Liquid Capacity... ............. .......ga S. <br /> i S;�c: Di�irnefer. . . .. .. ........Depth..................... ..... ... ........Do;)fh...................... <br /> D;sianco from nearest well - Distance from na6rnsf building...................... ........... <br /> Disfnnco to r03rQ%t !of line ... .... ............... ...... ...... .. .... t <br /> Rcmodolirg and/or rcpn;ring idoscr;boj: & .. ...... <br /> ............. ...... ....... PU....... , . . <br /> ............. .......... .... <br /> ....................... ... ................. .................... .. <br /> ............................. ......... .. ............ ................................. <br /> I keroby c ri;fy ikaf I kdvo propar d this Application NA +hat fha wort will 6o done in accordance with San Joaqukn County <br /> ordinances, Sts e. to -s, and rulol and '�Zlaflons of the S a q I Loc nealth Disfoct. <br /> .. .... .. .. ......I'l <br /> Vid <br /> (Signed)........... <br /> b, cod on reverse sidG). <br /> (Pio} plan, showing size of"10+, location of system in relatim '0 wo) c., can bo <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIO,'-i ACCEPTED B"r-"-..* . ....... ... . ............. ...... .. ..... DATE..�' . ................................. <br /> DATE ....... .............. ................ <br /> Ey ... ........... . ...... <br /> BIJI!.Dlh:G PE:KAIT ISSUED. ..... . . ..... . ... .. ............ ........ ....... . DATE.. -kA..... .............. .............. <br /> . k. <br /> Alferaiiont anti/or recommendations:.. ..................... ....... ................ .............................. ............... <br /> ......... ............... ................ <br /> ............... ... ...... ............. <br /> ........... <br /> Da fp ...... <br /> SAN JOAQU!N1 LOCAL HEALTH DISTRICT <br /> 30D Wit CJnti Street 13' sydamd'o Sfr*01 014 Ntrih "C" S1,.0+ <br /> M&M.ca. 17-61;11orpla Tracy, California <br />