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ry ------ USt:-2 /Jl - ------- -- I APPLICATION FOR SANITATION PERMIT Permit No. .... y {Complete in Duplicate) Application is hereby-made made This Permit Ex fres 1 Year From Date Issued Date issued __ ' (j_ f� ,., =� / y to the San Joaquin Cc" H" District for a permit to construct and install the work herein described. This application is made�in,compliance-with County Ordinance-N : 549A .., JOB ADDRESS AND'LO A ----------------------- Owner's Name > •----- ---------------------- ti x Address--- t ------------------ Phone----- •--------- -------------------- - ---------•-----------------•----------- .----------------• -------- Contractor's , ! `. Contractor's Name__'Y-_..__ - ------ ------------ --------------------------------------- Enstaila+ion will serve:f Residence _FPhone__.___.____•---•------------------- Apartmenf House:❑ Commercial ❑ 'Trailer Court E] Motel Number of livingunits: �' ., f he ❑ ,/�__-,Number of bedrooms�"_.Number of baths -_- Lot size �f �1r Ot l Water Supply: Public"system r # f Community system ❑ Private ❑Depth to Water Table - t Character of soil to a�depth of 3 feet Sand_C_7�C r yei"[]- Sa dy Loam ❑�iCfay Loam ❑ Clay,� "` Y— w�_=nn y ❑ Adobe Hardpan ❑ Previous Application Made: (If yes date____________________) .No®/New Construction: Yes Z�-<o ❑ FHA/VA: Yes ❑ No 9 TYPE OF INSTALLATION AND SPECIFICATIONS: " ®� (No septic tall-l:.or—cesspool permitfed if public sewer is available wi}hire 200 feet.) SepticCTank: f" "'D,istance from nearest well______ l J�> l� �" a .: r -----------Disfance from foundation-------------------Material a ry No. of compartment's------------------ - - Size.: !y'f,r i -------------- "liquid depth_ .� ,_..�. ----Capacity______________ __ Disposal f=ield: /,Distance from neo e=st well_.. - _-_pistance from foundation.__ -- ` - " ' _.___.-Distance to nearest lot line •.-_--- �1lVumber of lines___._v _--_- - --- ---- gth of each line_-- $ Width of trench_.--- T� of filter material,/1 p � -- �----------------- i yp ) i _ rDe th of.filter,material4 X- ---_--_Total length n =- Seepage Pit: -�� ---------------- Distance to nearest well_______ ...._Dlsfiance fr m fou dation-_ / i of its_. _ ____ = D�tae to nearest lot�l�� l P �----____-Lining material._ _ _�,��-Size: Diameter- ---- Number d I f S3 .. -- Depthc s Cesspool: Distance from nearest"welL____ _____Distance from foundation---._._.__-__`_,_..Lining material---- ❑ size:Qamefer.--------------------------------- Depth------- -------- ---- d '------------ ---------Liquid Capacity-.--------------------------gals. 1A Privy: Distance from nearest well__.._____---__-- _---__ * . , r Distance from nearest building ❑ D'istance to nearest lot line-- i r r 9-------------------------------- q -------------------------- - , ie---- Remodeling and/or repairing (describe) _ __________ -=--- Ir i 1 --•. -- ---------------------•----------------.---------------------------------•----------------------------- -----=---------------------------------- I hereby certify That I have prepared this application and that the work will be done in accordance, with San Joaquin County ordinances, State laws and rules and`retjulatio ^of-the"San;Joaquin-Lccal--Health--District•,- ._-Y.---- (Signed)-------------- ______ ____ By:-------------- =;: :. r orttract Titl or ___ 410. (Plot plan, showing"size of lot;location of syste relation,to wells, buildings, etc., can be _.be place r de). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ * ` ' ------------------------ ---- - REVIEWED BY ------------------ + - DATE i - a --- -------------------------------- 6_ . BUILDING PERMIT ISSUED_-_ - D ATE -------------------------------------- --------------- ------------- - ---------- ---------------- Alterations and/or recommen ations:.---�_----_- _------ ---'� �kDATE Alterations _ �', --------- .•-- ._ ---- --- ---- -- ------- --------------------------------------------------------------- . �a ..ate,. E -- FINAL INSPECTION BY:.-__ .- .e,e.E1 --- ----- -�- -------- - Date_... ---�' `-- --- --a-l. ----------------------------------------- 4 SAN JOAQUIN LOCAL HEALTH"DISTRICT !f 1601 E.Ha:ellon Ave. 300 wes!-O � 124 Sik'amore St"'re`e+! . Sfoeklo+i Callfarriia -_Lode,_California__ v 205 West 9th Street �1- -Manteca,California ES 4 REVISED 9.59 3M 3-•S3 F.P.CC, Tracy,California �1