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FOR OFFICE-. USE- .......................................... APPLICATION FOR SANITATION PERMIT Permit No. --.-.----_-_--___--.-4s" -1_ (Complete in Duplicate) Date Issued ... ............................ . . ........ ..... . This Permit Expires I Year From Date Issued %WApplicartion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. JOB ADDRESS AND LOCATION Owner's -- --—-------- -------- —---------------- Address_ ------- Contractor's Nam_-------- Installation will serve- Pasidence ag�-Aparhnert House 0 Commercial 0 Trailer Court 0 Motel 0 Other 0 Number of living units: Number of bedrooms_,X Number of baths ./-___ Lot size ................. Water Supply: Public system ❑ Community system [] Private [Depth to Water Table nIF-_ ft. Character of soil to a depth of 3 feet: Sand [] Gravel[Sandy Loam 0 Clay Loam 0 Clay[I Adobe 0 Hardpan 0 Previous Application Made: (If yes,date . -- ------I No [A-'Now Construction- Yes a No [] FHA/VA: Yes [I No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank Or cesspool permitted if public sewer is available within 200 feel)e Septic T nk Distance from nearest well_jv�'W,0 " istaince from foundeficia-Z.4-0--'--.Material--.- No- of compartments-----1t!::-----------Size_.1eXZA,_kA-__Liquud depth---- .F-._--_C*pacity_.,_10"..� Disposal "etd: Distance from nearest weII__A0,o___*'Disfance from founclation-"t-e-_Distance, to nearest lot Number of lines.-..._ ..._--....._Length ------------Length of each Width of tmnch--.;W--- -------- Type of filter material-i*W.<_____Depfh of filter material_;df .._.....Total length Seepage Pit: Distance to nearest well_.____.._-_._Distance from Distance to nearest lot line.--__.._.._ Q,` ine-------- QNumber of pits. - - _Lining material-------------------_Size: Diameter------------------_Depth- Cesspool: Distance from nearest weI1..___.___._D;stance from foundation --------------Lining material--.. ............ Size: Diameter. -----------__Uciuid Capacity...................--galls. '-�'Vrivy: Distance from nearest __._..Distance from nearest building..—.._._.._._--.--._ f ❑ u3ding-__-.--_- 11 Distance to nearest lot line-----__.-____-____"__.""_-._._._".. - __----—--------_------------------------------------ ----------- Remodeli 9 or repairing (describe) .4a _J --C 7- --_-------------------—-------- ------- ------ ----------------- --- -- ------- -----------------------------------------_______________ -----------------------------------...... ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State id recjulaiti�ie of an Joaquin Local Health District. �ancl or rules and d/or C reXS11------ ------------------------------------ �&Mv (Signed), I onfracior) By: _ .- f!% _------------------------------------_-------- (Plot plan. showingsize �i i;,-[, of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.........----—---------------- ----------................... REVIEWED BY--•-------------- DATE ---------------J BUILDING PERMIT ISSUED--------_---_--- ......... Alterations and/or recommendations:.----_-_--'------------.-.------•—.----____._.____------------_._„ ------ .......... ------------ ----------- FINAL INSPECTION BY: Date---------'-- �--1=--`----------.._.__.-. SAN ate---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1607 E.Ke..Ifon Ave. 300 W.,1 Oak Street 124 Syco..Street 205 w..1 9th Strw st..kf..Callf..10 Lads,C.Isf*.i. Mani.,.,California Tracy,California F.P CO