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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. :�J.�......... - ---- ------------- (Complete in Duplicate) Date Issued ._�.-�2�� ......................................................... This Permit Expires 1 Year From Date Issued "1 Application is hereby made to the San Joaquin Local Health District for a permit to consef install the work herein described. This application is made in compliance with County Ordinance No. 549. Cr�M.��7s RSD-� .rte/ JOB ADDRESS AND LOCATION__7r'h�cl f✓o__. I..C' _ _`.�f L /�??fJ�---C. /,��9 i --------_---p-T--------/--- Owner's Name _ A ------- /,�--- - ,Q_Lrl4r✓_l/ Phone s' Address = ='�m 5l t� ... ------------------------ Contractor's Name------ r9.C° �Sffp.�f5 j / C`--------------------------- ----------- ---- Phone_ _1, © Installation will serve: Residence,® Apartment House ❑ %Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ "Number of living units: =-.l-_µNumber of bedrooms -3__ Number of baths 14—Lot size ___ !"v' __X__ o___ __________________ Water Supply: Public system ❑ Community system ❑ Private [W Depth to Water Table "G- ft. n PP • y ❑ ❑ Y ❑ y Clay dobe ❑i Hardpan N Character of soil to a depth of 3 feet: Sand Gravel Sand loam Clay Loam Cla A Previous Application Made. (If es,date-..____------------) No New Construction: Yes No FHA/VA: Ye' �' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: " '(No septic ta6V'or cesspool permitted if public sewer is available within 200 feet.) _..trk / r Septic_Tank: Distance from nearest well_-�Q-_____Distance from foundation®, _-_s.-._.S r._.._ No. of com artmen ...__.�v-------------Size----- ---Liquid depth----- CapautY/;?220_� /c r � i Disposal Field: Distance from nearest well..�Q-----Distance from foundation-ZO-------.---Distance to nearest lot line--'s --- Number ofines-- -------- each renc ��y ._._.. lines-- of h line_ _'4!?_- �_S�Width of trench_,;__"_- �................. �I Type of filter material-- //6e6i '__Depth of filter material_. ../.g_._______._Total length____ ..t _._ ------------------ Seepage Pit: x Distance to nearest well__/0d9__/__-Disfance fW m foundafion_Z61_/__----.Distance to nearest lot line..^S ...... D]; Number of pits.`-.A-------------Lining material- -...Size: Diameter__.7t�E__y-.-----Depth'__. , -----------._--.._ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__._ -------------------------------- d El Size: Diameter--------------------- ----- ----------Depth--------------------- - - -------------------------Liquid Capacity- ----------------- 9 Privy:+ `D.istarice from nearest well_________________________________________________Distance from nearest building------------------------------- ❑ `` 'Distcet'o nearest lot line--------------------- - -----------------•------------------------------------------------------------------------ - - ., Remodeling and or. repairing describe :____----_ ` -------------------------------------- -------------------------------------------- ------ ------------------------------------------------------- - +-a ,-- 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, rules and regulations o San Joaquin Local Health District. (Signed)---------------�-----------��. �.�� --- ------ '---��--r -----'��--�---'---------- -- -------------------- -- w and/or Contractor) BY ----`-= ------------- Title) ` (Plot plan, showing size of lot, location of ystem in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY--- - -- - - -------------------- - ---------------------------------- DATE-- --- - -------------------- REVIEWED -- -----------REVIEWED BY------------------------------------------------------- ----------------------------------- --------------------------------- DATE-----------------------------------•---------------------- h BUILDING PERMIT-ISSUED------'- "'-------4----:.a_ _ _ a T' "DATE_�----------- Alterations and/or recommendations:---------------------------------- ----- ----`---------••--------------------- --------------------------------------------------------------------------- -------------------------------------------------------------------- --- •---------------------------- ------ --------------------------------------------- •------------------------------------------------- '% a ---------- -------------------------------------------•----------------------------- - ------- - ----------------------------------------•----------------------------------------- -------•--------------------- OL --------------------- - ------------------------------------------------ ----------------------------- ------------------------•---------------------------- ------------------------------------------- i FINAL INSPECTION BY:.-I r��J ''4•�?1" --------- ----------- Date_ E '_ z..- --- ------ ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lad!,California Manteca,California Tracy,California F.R.C Q.