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AP PLICATION FOR SANITATION PERMIT ;• {Complete in Duplicate} Permit ' This Permit Ex fres I Year From Date Issued � Application is hereby made to the San Joaquin Local Health District {ora permit Date Issued This application is made in Acompliance with Counfiy Ordinance No. 549- A. Ip to construct and install the work herein described. JOB ADDRESS�:,gNb LbCATION.____ Owner's Name_- - 70 - A, Address - ��if '`- --------- ----------------------------------------- -----•- ------------- --- �- Phone.----•----- Contractor's Name__ ------------------------- f� Installation will serve; Residence Apartment House a�r_� Phone-- _ ❑ Commercial ��.{ �'�-��-Q•-�-- Number of living units: ___--___ Number of bedrooms -------- X Trailer Court ❑ Motel Number of baths ------ ❑ Other ❑ Water Supply; Public system Community-system Lot size --1�p,� Character of soil to a depth of 3 feet: Sand ❑ Private ❑ Depth to Water Table , Previous Application Made: Yes ❑ No Gravel ❑ Sandy Loam ❑ Clay Loam New Construction: Yes ❑ Cs E❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECI CATIONS: NO ❑ F,HA/VA; Yes ❑ No (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 5e tic Tank: p�f �Disfiance from nearest well_-__I ��Disfance from foundation_ arNo. of compartments = .-----_.Material-____ __' Size-42"' .. ,f ! X_.,� •------ Liquid depth_ .rrC. - Dispose Field: Distance from nee est well.- /E-Distance from {oundation-" _Q*f ' s��---------------Capacity---�� Number of lines-_-___ - i~ •._�.— X- --_ Distance to nearest lot ------------ -----Length of'each fine--- I �rType of filter material-_- --------- -----Width of trench___ -L _ --___Depth of fifer material f Seeps e Pit: Distance to nearest well - ------------------------- - ~p w Total length__--- � I ti Kl�__.Distance'from {oundation_�(p------__ --.pistance to nearest lot line-- Number of pits_-_ �_ '_ Lining material___ . f7 Cess ool'; ,C/G-----Size: Diameter____ I� p Distance from nearest well----------------pistance from foundation.._:---. --- Deptl,_.._._2..r-'— ❑ �, S. Diameter.---------- -----Depth--------------------------t pY Lining material ---------------- f Priv ; Liglid Capacity------------- Y' Distance from nearest well --------------------------------- gals. Distance to.nearest lot line------------- Dis#ante from nearest building ------------------------- -- - ------ ---- --- - Remodeling and/or repairing describe)_____________________ ' ------------------ � ) ---------------- ._ ------ i------------------------ --- J _____________________________________________________________ _ _________ ,1 I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ordinances, StateMla, ,and rules ulations of the San Joaquin Local•Health-District. q County (Signed) . -- --- - ------- ----- ------------ 0 BY:--------------------i---------------------•-•---•------ ------- - � wrier and/or Contractor) {Plot plan, showing size of lot, location of system in elation to wells, buil s, etc., can be Placed on revers _ e side). v FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_- ,-__e_,. REVIEWED BY_ ------------- DATE--------` — -- -- --------------------------------- UILDING PERMIT ISSUED --------- ------- ---------------------------------------------------------------- DATE-- •---•-•-------------•-- ------------------- p * --------' ----AlteMons and/or recommendations:_ ` �� _ f - --- 4 _ - - _ - --- - ------ �F - �.. = �--- 7 - --- ------------------ -------- ---------------------------- ---- -------------------------- 2>y-�j-: ., �--------------------------- FINAL INSPECTION - -------� � --- - Date_.---=�- �-J-�-~---�0• �--•------ -- -- ----- - - - - ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wesf Oak Sfreat more Stockfon, California Lod132i, California Manteca. . Cal Streat 814 North "C" Street ca, California Tracy, California FS-9-2M Revised 8-'59 F.p.Co. +W r