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. . � \ . APPLICATION FOR SANITATION PERMIT Permit No. .-'? '___ ��mp|m� |n Duplicate) Date |muoJ ' ��W,�Applicafion is hereby mu�nfo'fhm San Joaquin 'Local Health District for u permit to construct and install the work herein described.' This application is mode incompliance with County Urd'nann: No. '49.JOB ADDRESS AN � '^ E ( -------- Installation will serve: Residence 0, Apartment House LI Commercial 0 Trailer C"".. Ej ....~. []. ~..~ ^] � Number of living units: J--- Number of bedrooms --2--Number of 6u+h,/—' Lot size ----------- 8��X----/Z4/Z47---- Water Supply.Supply. Pu6lic sysfem Community system El Private E] Depth to Water Table ft.-' .-' Character of soil to a depth of feat:`� 3omd [] Gn,vo| Sandy Loom E] Clay Loam E] {Jay [l Adobek Hardpan [] Previous Application Made: Yo, ^ NoX New Construction: Yo, El Np jR FHA/VA. Yes E] NoSi' � �PEOF INSTALLATION AND 'SPECIFICATIONS: ~ (No septic tankor'm*ss�*o| por,n�tm6 if public sewer isavailable wR6in 200 feet.) -^� - teh� . .. ~� Septic Tank: Di�once from nearest well_- ----uisfunov f mmfouo�u+ion- � �� _ ° = ~,~ ~ ~ ~^ _ f � r� - 'Capmci+y---JV_0.No. -ofcompa�monf�-----�° � —.. � - - Dp ,al Field: Distance from 'nearest well .-- ��_Distance fromfo ndatio ----------------- Number oflines |ine� ' Long+ o| aochUn�-- � �- '---'v /um �� on'�-n--'-�-..-� __�_ «� �no+�Typeof�N+er m Depthof ��*, mute�uL' A9 -�o+� ` SnapugePit Distance - ~ from fouo6�+�n..__.._-'D�+Distance _ El ' Number vfp��.''-'-_--''L�ing material------------------------ [�ometur'--^'-'''-Dep] ''-'--_-'--'- Cesspool: Distance from nearest well - ' *�L-_---Dldan from 6o'un�o�on_ .--..--_Lining matv6oL--------�.----'.__,.- gals. El S�o: Diameter�-'' �--�-=��-'-''Depth'-'''-''-_''-''''-�---.Uqui6 Capacity . - Distance �om nearest *eU----------.—.---.D�+ n�e from noo.e` bi|6|mg ---------------------- Distance . --_- [8�unxn-fono�nyst-|v+'|ime---------''-'''-`'----------------------------------- I-_________-_______, �_.__'______.______.____Remo6eing and/or,repairing (do,cr�*)�'--------,----_'__.__---_-__-_- -------- --------------------------------- ___ _'-__.__-_-.—_-,__-_----------------------------------------------------.--------- --------------------- ------ -------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- -------'''--'-----''--'--'-''---'— V i ' her- certi fy th on and that the work will be�done in accordance with San Joaquin County ordinances, Sfa aws, and rulasrob d regulations of the San Joaquin Local Health District. (Signed)_ --------(Owner and/or Contractor) ' -y (Plot plan. showing.size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). ------------------------- DATE-------------/__Tj. .... ------------------ ---------------- Alterationsand/or recommendations:---------------r---------------------------------------------------------------------------------------------------------------------------------------- __..�-_._—_--_'-_-__.--,_--_---.`.--.----_-_._--�--_--._--_-----._---__-'._- '--'----''-'---''--'--''-----''--- ._ -'-_---_— ---'.. � -'''--'-'--'-'-_-''-''--'-_—.—._. ~ '-' -�1 '�^-r-------r'-''- ---_-'--'_---''''- -`'-'''- ------------------------'''-''''-''---'__----------------------- --------------------------- --_'_-''--'------�'-- . /� /� Date- //- �� '�. --------------------------------------- SAN F|N'�L INSPECTION �8Y:..!°r��z��.`/��--.. Z ' - -' --- . ------------' _ � SANJOAQU|NLOCALHEALTHCUSTRICT oo s"°m American Street ^ 30D West Oak St,*°+ oz s'""m"re Street ow w"+h ^C^ Street Manteca, California| Tracy, California California Lodi, California "m °. " ,"° Es-9-2w n°.is"a 1'57 p�p.Co , _ ° . , .