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�tiyy APPLICATION FOR SANITATION PERMIT Permit No•j_._J.l-_�.r� (Complete in Duplicate] pate Issued ----- -mar/70 I This Permit Expires 1 Year From Date Issued Application is'hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. rt1 �. - /- JOB ADDRESS AND LOCATION ---- = � - f ----------- Phone Owner's Name - - - - -----------•------•------------ ` -------•--------••--------- ti --------•-- Address_._-- -- --•- - - f a '`•�, - Phone. Contractor's Name--------------- f'�,A—� Trailer Court ❑ 'Motel Other ❑ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ ; - 'Lot size Number of living units - Number of bedrooms _ ._ Number of baths ____.__ f i Community s stem El Private Depth to Water Table --, Water Supply: Public system ElY y y Clay Loam Clay ❑ Adobe Hardpan ❑ " Gravel "' Sand� Loam ❑� Y ❑• _ I Character of soil to a depth of 3 feet:" Sand ❑ ❑ No [}� Previous Application Made: 'Yes ❑ No New Construction: Yes ❑ No UKFHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feef.) Material__..._________----____ Se tic�Ta k:. Distance from nearest we4l_________________pis#ante from foundation--------.----------. � Capacity_ -- ------- ----Size-------------------------------- Distance _.-------------- -- ---- -----Llquid depth---------- -- - "------ �-------._.. No. of compartments-..--___-_ ---- - / .- ----- _.Distance to nearest lot -' � Distance from foundation..- � �� Disposal Field• Distance from nearest well- Width of french... 5f "Number of 4ines----_"-_--/--�---- ----- Length of each line___ �� ------ r,. Total'length_.__.xo?`"----------------- :.. "� Type of'filter material � � Depth of filter material___- ---------- -�� / foundatione ________.Distance to nearest to line_ _� ^` ____Distance fr _____. � Seepage Pi}; Distance to'nearest well- .r ----- 4 -C",-Size: Diameter ' �� --------Qepth "', umbe of 'i' `� .❑ + t. ,.R.+ r_k.N s �� Lining -------------------Lining ing materi-al____:.__.__.___"______".______.____ e from foundation Distance-fromnearestell_ material--- r ' Liquid Capacity----------------------------gals' Cesspool: Depth ----- - --------- - - Size: Diameter--------------------------- -- - -------------------------------------- ❑ # = ' --°- Distance from nearest building Dis+anCe from nearest well----------- - ------- 11 ------------------------Privy: d pisfiance-to nearesto : ___ _ --- ;_ � e -- - ��f l Remodeling and/or repairing (describe --------------- __-_------ ------••--•-------------------------- �. ___________________________________________________________________________ i ----...----"-------'-- ----------- ------� r---------------------"------:---'-------------'-------------'------"---- - I hereby certify that I have prepared this application lli the San Jothat aquinhLocalkHealtheDistr'ic#n accordance with San Joaquin County ordinances, State laws, and rule and,regu t. (�or Contractor] ✓ ----------------------- By:_ --------------------- -- ----- (Signed) it L� ( _ Title ------ � ---- � - B --------------- ------ ------------------- --------Y (Plot plan, showing size of lot, location of syst in relation to wells, buildings, a+c., can be placed an reverse side). 1 FOR DEPARTMENT USE ONLY f DATE.__ '� r Z Q---------------------- ---------- APPLICATION ACCEPTED B _ _.. _ ,V- ------------- ------------------------- -- DATE------------------------ -------------- -------"-------- REVIEWED BY DATE -------------------------- ---------------------------------- -------------- PERMITISSUED------------------------------------------------------------— -------------------------------------------•------- --------- ------- ---------- Alterations and/or reco mends+ions: N "�: — `--•-- /� .-- rr - .--------- 4 - - -- ---------------- ------------- -_------_ FINAL INSPECTION BY:.__ "__----_-------- * SAN JOAQUIN LOCAL HEALTH DISTRICT w .� �. 132 Sycamore Street 814 Nor +h "C" Street i 300 West'Oak S+rest ;. ,� �. '- 130 South American 5treetJ +.� �. 'c •�.e� *� ¢Manteca, CaLfornia �� Tracy. California Stockton, California Lodi, California ES-9-2M Revlsed 8-'59 F.P.Co.