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.2_.. APPLICATION FOR SANITATION PERMITPermit No. .l .3..o (Complete in Duplicate) Date Issued _�-"------------• This Permit Ex ires 1 Year From Date Issued ,�. Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein descried. Tha application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__..__ _ -_-------�--�----- - ------ Owner's Name------------------------ i �.. ---—--- ----------------•------------ Add ress_.---,-"---- ------•------------ Contractor s Name---- A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Installation will serve: Residence ® p � Number of living units: __r.___ Number of bedrooms ._ _' _ Number of baths J---- Lot size ____""��=--�----•-------•---" Water Supply: Public system ❑ Community system ❑ Private, Depth to Water Table $"O. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) --------- Septic Tank: Disfance from nearest well _�P-----Distar�k fou datin_ de }h" M tenaL.-_= Capacity r ---- " No. of compartments--------:`---- Size-- Liquidp ' t Disposal Field: Distance from nearest well_50..------._.Distance from foundatnp/_b---------.W�d}h ofnce ttren nearest lot line___ _________ ' Length of each line---- "----------"------------ NumbEr of fines"___._��_____ -"__ __ -- g - Type of filter materia _. - -- Depth of filter materia --------- length___` - /-' ------ Seepage Pit: Distance to nearest we ______________________Distance from foundationDistance to nearest lot line Seepage Number of pits ------Lining material---------------------- -Size: Diameter------------ ----------Depth------------------------------- ❑ V Cesspool: Distance from nearest well________________ Distance from foundation-------------------- material__.__-___________---.___________._.. --Depth------------------------------ ----- ---------------Liquid Capacity----------------------------gals. ❑ Size: Diameter- -----'- ------- -----'- ---'- Distance from nearest building----------------------------------------- Privy: Distance from nearest well----------------------------- ❑ ---- -------------- Distance to nearest lot ine_______------------------- -------- ---- \n ---------=---------------------------------------------------- " Remodeling and/or repairing (describe):--------------------------------- --------------------------------------- ----------------- i ---------------------------- , -- ----------------------- - ----------------------------------------------------------•---------------------------------------------------------- ---------------------•-------------------- be I hereby certify that I have aesandregulationsthis application the San Joaquin the work Heallth Distnein accordance with San Joaquin County ordinances, State laws t. S� ned ►� --................ -----"-- ' {Owner and/or Contractor) ( �9 ----•- ----- -- - -- - -- - -- - ' '--- - --- --- ------------------------------------------------------------------------(Title)--------------------------------------- '-• - - -'- (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _ - ------ DATE--�-' -S'- ''0---------------------------- APPLICATION ACCEPTED BY _ _ DATE------------------------------------------------------------ REVIEWED BY----------------------------------------------------------------------- -- ------ -- --------. BUILDING PERMIT ISSUED-------------------------------'- ------------------------------------ Alterations and/or recommendations-------------------------------------------- -,-�-/; Z7 " '- " G ---- FINAL INSPECTION BY:.e - -- - -war-f' --------------- Date-- -'-' - ---------'- ----- --•----- "--'----' '--'-'--'----'------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C' Street 130 South American Street Manteca, California Tracy, California Stock+on, California Lod"+, California Es-9-2M Revised 8.'59 F.P.Co.