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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ur This Permit Expires 1 Year From Date Issued Date |ooue6 -.��7�------ �� Application is hereby made to the Sao Joaquin Local Health District for permit to construct and install the work herein described. This application ls made in compliance with County Ordinance No. 549' ^� � ' � J[>B /\DDRESS AND LDC�T|DN- .��-��.��- ��-. .. �a�------.��k' Owner's N -------------.---- Phone---_----_..�--- A6dmss_ ._--___._. ._--.___'_--_---.____--__-'_---_' -------------- Contractor's Numo,--,2 .--!!------------------------------------------------------ ------------------------------------------------------------------ Phone... ...............--------------- Installation will __|nstallationvill serve: Residence E] Apartment House [-] Commercial [Z Trailer Court E] Motel E] Other [] Number of |iVing units: -------- Number of bedrooms __ Number of baths -;�- Lot size _--__-._.--- Wafer Supply; Public system F-1 Community system [I Private X] Depth to Water Table Z!2. ff. Character of soil to depth of 3 feet: Sand E] Gravel E] Som6v Loom El Cloy Loam 0] Clay [] Adobe [] Hardpan El P,u"|ouu Application Ma6m: No Ne° Construction: Yes NNn [] FHA/VA. Yes DNu [� TYPE OF INSTALLATION AND SP�C|FiCAJ|ONS; (N* sopf|u tank or cesspool permitted if public sewer is mvmUm6le within 200 feet.) � Septic Tank: Distance from nearest we|L.^.�.------Distance from fovndu+ion..1P------------KxufeioLPm"t��--------- No. of compartments-.��---_-..3|ze�-&�.*�� ui� 6opf6-.Jr��.� ---.(�mpooify.��P--- Disposal He|6/ Distance from nearest voU..� -----------Distance from foun6a+ioo..//0-----------Distance to nearest |o+ line-r-._.. mbeof | ! Length of each U -4�-------------------Wid+ of �V Seoouoo Pit: Distance to nearest we| ljq/��. Distance from foundation---J"�2-----------Distance to nearest lot line-..4-_-- FK1 Number of p;fs-./--''--_-Lining ---Size: Diameter--94------''-Deoth-'.L,-�-,-----'''- Cosspoo : Distance from nearest well .--_.-Distance from foundation--------------------Lining material --------._-- � El Size; Diameter ---_'-'-'''-'-Depf h_''''---_'''-''''----Uqui6 Capacity---------------------------gals. Privy: Distance from nearest well----------------------------------- from nearest building------------------------------------------ CIA F1Distance +onearest lot line--------------------------------------------------------------------------------------------------------------------------------------------rA Remodeling and/or repairing (describe):---._---.-'-_-___-__---'_.___-.--_---.__----'--_- _'--_-,-'-_''-''--''-''-_'-_--'-_--_-�'---_-''-_--'-_.-''''_-.''----'-''�-''-''----''-'--'-'-_ '--------------------''------------'-'-------''--'--'--'------'-------------' -'-''-''--''----'--''---'-'----''----'--''''----''---''--''''--''--'''--'-''------''''----'- | hereby certify that | have prepared this application and that ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Plot la�m,7showin 7size of�l�o�f. ile'ation of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY Ar REVIEWEDDY-------------------------------------------------------------------- ---------- ---------------------------------------------- DATE-------.-_--_________ 8U|UD|NG PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------------- Alterations and/or recommendations:--'--------------___--'-_--__.____-_-----'______.__.. '-'-'-'''--'-'--''-''--''''—''-'''''-'''--''''--'-'--''''--'''—'-'-'''-'--''--'-''--''--'--'- -'''-'-''--'''--''---''---''---''—''''-''''--''----'---''''--'''-''----'--'--'''---'-''--'---'-' --------------------------------------------------------------------------- ------------- --------------___------------------------------------------------------- --------------------------------------------------- �� ---------- - - ---- ---- � FINAL |N�PE��|ON 0Y �_ u ��-� -------. Dafe.�.--------.---------- -------------------------- SAN JOAQVUN LOCAL HEALTH DISTRICT /nn South American Street so@vv � Oak Street /3o Sycamores�°° ow North ^C^ Streete""k+"". o"|m,,"/° ,L"a/. C^|a","/° Manteca, California Tracy. California ov-,m xe,.,"* u'5v ,^c"