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�. APPLICATION FOR SANITATION PERMIT Permit No. _471 (Complete in Duplicate) r Date Issued ._/6//_5_ . Applica+ion is hereby made to the San Joaquin Local Heal#hDistrict for a permit to constr f aaand iinnsta I the work herein described. This application is made in compliance.withCounty.Ordinance-No- 549. J08 ADDRESSND LOCATI N---- rf- Owner's Name_ �. 1�►±- h ..I s. /* ry -----------_ Phone_ ' '3 • `3 Address-------------------------------•------------- �,"-•-F�--�t�-�-----.�,.---------�-_��------- -----•----------------••----------••-•--------------•------------------------ Contractor's Name '✓F.v+. _ Phone..9.tn!F4Q_7 ❑ ❑ Other - --------------- Installation will serve: .Residence Apartment House � ❑ p ❑ Commercial ❑ Trai er Court Motel ❑ Number of living units: ___"____ Number of bedrooms ________ Number of baths�--- Lot size _--a �fLe Water Supply: Publics stem PP Y� y ❑ Community system ❑ Private � Depth to Water Table _:��. Character of sail to a depth of 3 feet: SandGravel ,vel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe , Hardpan Previous Application Made: Yes ::.N New�Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) epfic T nk� Distance from nearest welt_________________Distance from foundation---------------.___.Material----------- "._________"_..__.______" --------•-• CI} �-1 No. of compartments......-------------- -----Size--------------------------------Liquid depth------------- -----------CapacitY----- ---------------- P p+ap Rep- Distance from nearest well_________________Distance from foundation.-______---_______--Distance to nearest lot line---..___•---__--- ��') Number of lines-----------------------------------Length of each line------------------------------Width of trench r Type of filter material-------------------------Depth of filter material-----------------------Total length____-____________---------" Seepe Pit: Distance to nearest weii.. 4_ _-__Distance fro foundation__ _.Distance to nearest lot line_ 4' *-0- Number of pits.___.__"..___-Lining material .....Size: Diameter_""If? ._"""Depth_"„2,,_��i�.!(_--- Size: Distance from nearest well___-______-"____Distance from foundation__."________._.__".Lining material______.____ _. -� ❑ _- - _._.Sizer Diameter -—_-----De,oth----------------------------------------------------Liquid Capacity------ -------gals. Priv : Y Distance ,rom nearest well____________ Distance to nearest lot line--- _ -"___________---__ _ .___________.___-______-_-Distance from nearest building--------------------------------- ______ ___ Remodeling and/or repairing (describe __ _______________________________ ____ ------ ----------------------------------------- ----------------------------------•---------------- ------------------------------------------------------------------------------------•-------------------------------- f hereb rtify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, fa laws, d e�and regulations of the San Joaquin Local Health District. I Si ned - - ----------------------------- By:.--•-------•--•--------------------------- - (Title) __ ontrac+ - ot plan, showing size of lot, loca+iori of system i elation to wells, it ings, etc., can be p cad on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ ___REV DATE ----------------- IEWEDBY------------------ --------- -------------------------------------------- DATE-- -.. ------------------------------------------- BUILDING PERMIT-ISSUED---------------------------------- DATE ---�----- Alterations and/or recommendations:________________________ ----------------------------------------------- ------------------ -- -------------------------------------------------------- / F1NAL INSPECTION BY:.____ _ ________________ Da#e_ ---__ _- - • / /' ----- _ ------------- --------- SAN JOAQUIN LOCAL HEALTH id STRICT r 130 South American Streef 300 West Oak Street 132 Sycamore Sfreef 814 North "C" Street Sfockfon, California Lash, California' Manteca, California Tracy, California ES--9-2M ; IRevised W-2100