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APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />This Permit Expires 1 Year From Date Issued <br />is hereby made to the San Joaquin Local Health District for a permit to construct and <br />ESS <br />me <br /> Phone <br />4STALLATION AND SPECIFICATIONS: <br />:optic tank or ;esspool permitted if pub4 sewer is available within 200 feet.) <br />d: <br /> No. of comoartmentL . .. Size 73.. )c..5-yet.i.Liquid depth ... .. Capacity 7O 4 / <br />Distnnce from nearest we 510 I Distance from foundation./0 Distance to nearest lot 9ne..6 1 r\(umber of lines. <br />Tipe of filter material. 9t?/ P 7( Depth of filter material.. ../Y 7'. _Total length <br />D;stInce to nearest reli .Distance fr m fpqndation tanchto nearest line, S Number of pits i <br />Dstanr.e from neared' we, Distance from foundation..../.0. .. Materitl. <br />Size: Diameter <br />Distance to nearest lot line <br />Distance from nearest well <br />Distance from nearest well <br />— 1.,n;ng material4 r.t. Size: Dia riet Jr. . v.... Depth. 5- <br />..... Depth. Liquid Capacity gals. <br />.... Distance from foundation ... Lining material <br />Length of each line 11) Width of trench <br />Distance from nearest building <br />. ... <br /> <br />iv <br /> f <br />and/or repairing (describe): <br />y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />State IawindQr as regulations of the San Joaquin Local Health District. <br /> <br />(Owner and/or Contractor) <br /> <br /> (Title) <br />lowing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY —•-------•-------- <br />)N ACCEPTED BY ..... DATE. <br />- BY DATE ERMIT ISSUED. DATE <br />C /- c'i . <br />C-- <br /> • L r • = . <br />2 - ,ez 7 <br />Br'. Date 2 ;7' <br /> <br />-.c. e":,.1 t-‘ <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />h Arnorican Street <br />on CcIr'ornia <br />300 Moo Oak !moo. <br />'.odl. <br />124 Sycamor• 5tricto <br />Mnntoca, California <br />205 W•st 9th Shoot <br />Tracy, California <br />tion is made in compliance with County Ordinanc No. 4 . <br />Norm, C(1 -11- <br />I <br />, aif • 7g) :4 <br />o WI r <br />LOC2T19IN 117 II- <br />... . <br />114..cAlperry <br />"ter ho <br />Phonon', <br />Permit No. <br />Date Issued -7 " <br />install the work herein described. <br />111 <br />nd/or recommendations: <br />4 4 C ey' <br />aitt 7. - s <br />ir. ••••• - • ' <br />-71. • - c" <br />.47.1‹ <br />vill serge: Residence 0 Apartment House 0 CommercialA(Traile CourypIo6V €9441rrs)6) <br />)e, of living units: Number of bedrooms Number of bars"- of size <br />4M /5704 X 75-0 ly: Pub ic system 0 Community system 0 Priv a teM Depth to Water Table ft. / <br />f soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam 0 Clay Loam 0 Clay 0 Adobe , Hardpan <br />plication Made: (If yes, date I No 0 New Construction: Yes' No 0 FHA/VA: Yes 0 No 0