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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued. ...S&31(,-0 This Permit Expires I Year From Date Issued herein!de!r',bed Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work iris application is made ;n compliance with County Ordinance NO. 549- G L . .... JOB ADDRESS AD LOC ITION Phone......_......................... N Owner's ....... N am*. 0_0 Z --- ---- ....................... ....... ................ __YApartmerit Ho Adclress.-J-k. .. .....6..'?/ I i . Phone......--_-._......... Contractor's Marne...... ......-.1-............ ........................ ....... use-n Commercial Trailer Court ❑ MiDiel 0 Other El installation will serve: Residence 4 Number of living units.4':!2 4 Number of bedrooms........ Number of baths ........ Lot size system 0 Cc,�nmunity system C] Private Depth to Water Table Water Supply- Public IV I ir \ Gravel 0 Sandy' Liam Clay Loam 0 Adobe 0 Hardpan C1 Character of soil to a depth of 3 feet: Send El G previous Application Made: Yes D No)X Now Construction. Yes,0 No FHA/VA-Yes 0 No J!5, TYPE OF INSTALLATION AND SPECIFICATIONS: �Iic, (No septic tank or cesspool permitted if Pu s or is available within 200 feet.). I a erg -f;c Distance from nearest well.., ce fr fou d ........M P belt y,. So Tank: Liquid clep�h_-.I*e a pa 0. of comparim .... .....Size; N1 _........._.:.....Distance to nearest lot �arest well from foundation D;SV.l*al Field- Distance from ne7-,-, ach.1111, ' Width of trenc�l .... Number of Lines...... Len of ft .........- a-- - � -Le'","' , material......,. length--- Type of filter me of filter, ferial, -.41�_ fh�o Se nea-est lot line........, er) e Pit: Distance to nearest well___ ..............._,..Distance to ❑ e Pit 7S�z�b, Diameter. Lining material.... ...... Number of pits......_.._._.....,..Uni .......... Lining material.-................. Cesspool: D*starxe from nearost wall.................Distance from foundation.........._...... Size: Dlama�er...__. ...... ..........-----------;4- t.-Liquid capacity.....------- ❑ 'nce from �aalresl building �...... ............. Privy: Distance from nearest well .................... Distance to nearest lot line.. ............... ...... Reirrijoallng and/or repairing (describe V....... AA . ......... ..... ou ". I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin +y C ordinances, State laws, and rules and regulations of the'San Joaquin Local Health District.' _(Owner and/or Contractor) .......... ........ T-............. ........... V.Z�A,� - I.................................... ------ -------- ........ sy:_ str- reverse side). (Plot, plan, showing size of lot, location of system in relation to wells, buildings, can be I placed on FOR DEPARTMENT USE ONLY --j.... DATE.......-..APPLICATION ACCEPTED BY ......... ........ REVIEWED BY._._.....__--- ----- ...... .......... ....... ....... .........1 DATE_,_70 1......j- ..... - DATE.- ....................... ... BUILDING PERMIT ISSUED... • ------ ------- ..........I.........-............... Alterations and/or recommendations .. ....... ............. ........ .................. ........................... .........___..,.. .......................... ....................... . ....... ....:..I...... . ..... ........................... ...................................._.»»» k............ -.... .......................... Data___ ........ FINAL -INSPECTION BY:._... ............... ....... SAN JOAPUIN LOCAL HEALTH DISTRICT 300 Wl"+oak Strut 132 Sycernoto S+t*vt 914 North "C" S1ifQQ+ 130 1,South American Sfrae+ Manteca, California Tracy, eahforn;a 3 Atcck+on, Cafiform;a Lodi, CaliforniaI