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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Permit No. /Z Date Issued A This is hereby made to the San Joaquin Loca� Health District for a permit to construct and install the work herein described. 's application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION --------- SltY_ �2 0 ...... ? --- CL� Owner's Name --------- M"r-A V__2 ------------------------- ------------------------------------------------ 1__._1 Phone#& ---- — --------------- Address ----------- f ---------- -------------- ----------------------------------------------------- ---------- Contractors ---- ------ Contractor's Name - ----- A--� ------- "R ------- --- ---------------- Phon Installation will s4:z Residence 4 -"Apartment House E] Commercial E] Trailer Court E] Motel E] Other F -I Number of living units: -.-/--- Number of bedrooms -:K Number aths __/ Lot size ____ --- .07�7_x ----- Water Supply: Public s)rstem E] Community system El Priva � �Depth to Wafer Table .4- --- PP�f f. Character of soil to a depth of 3 feet: Sand P� Gravel E] Sandy Loam F] Clay -6m[j Clay[] Adobe 5_<,rdpanE1 0 FH Previous Application Made: Yes E] No E?'*' New Construction: Yes El N FHA/VA: Yes E] No L] TYPE OF INSTALLATION AND SPECIFICATIONS: I Nseptic epfic tank or' I cesspool permitted if public sewer is available within 200 feet.) - Se tic T, Distance from nearest weH ----------------- Distance from foundation -------------------- Material ------------- No. of compartments --------------------- Size -------------------------------- Liquid clepth -------------------------- Capacity ----------------------- I I 5__--4--jr , Ispo ie Distance from n"resf -well, We :_:Distance from Jounclation=1_0_1 "Distance,fo nearest -lot line_____:,?_-----_- - ine ----- Numl�er of iin'es ----- I ----- --- --- , -,-Length of each line_____ 9_0 ................ Width of trench___ MZ. V _11! 0 0* Type)of filfermaterial -Depth of filter material J9 . ....... Tof,l length -------- ---------- & ------------------ --- ------------- Distance to n F nearest weff ------- I-00 Distance from foundation ---- ----------- Distance to nearest lot line ------- Number of p.its._ - I ------------------ Lining maferia1__RcwJ-_-, ----- Size: Diameter'___6__-5_." ----Depth ---- Z-4 . ................. Cesspool: Distance from nearest well ----------------- Distance from founclat77-� .......... Lining material___________________________________. ❑ aterial------------------------------- El Size: Diameter------------------------------- ------ Dept h ---------------------------------------------------- Liquid Capacity ---------------------------- gals. Privy; Distancefrom nearest well --------------------------------------------------- Disfance from nearest building____________________________________._._. L1 Distance to nearest lot lin ----- --------- ------------- I ------ -- ------------------------------------- ---------------------------------- Remodeling and/or /or repairinq (describe) ------- -- -- -- -r-- ----- --•l--- A -P- - ------ -------------------------------------- ---------------------- --------------- - ----- --- :0e ---------- ---------------- -------------- _ -------------------------------- _____________________________________________________ ----------------- ---------------- --- -------- ----------------- ---------------------------- _-_ ------------------------ --------------------------------------- ------------------------------------------------------- I ------------- ------------------------- ------------------------------------------------------------------------------------------------------------------------------ I hereby certify "a' I have prepared this application anci_A`atili�ework will be done in accordance with San Joaquin County ordinances, Sla e and rulesn regulations of the San Joe Local Health District. (Signed) ------------- ... . .------....AK 7, By: ---------------------------------- 7 -------------- -------------------------------------- ------------------------------------- Contractor) --------- (Title) ------------------------------------------------ --------------- (Plot plan, showing size of lot, location of system in relation can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ----------- - ------ REVIEWED BY -------------ie-- ----------------------------------- BUILDING PERMIT ISSUED______________________-_____ - --------------------------------- Alterations and/or recommendations______________ 7� ---------- DATE _*1, __( ---------- DATE---------------------- - -------- DATE ----------- I � --- - ------------------------------------------------------------------ ----- ------------------- ----------- rt ----------------------------------------------------------- I ------- ---- ---------------------------------- ------------ ------------- -------------- :Z-_ ----- -------------------------------------------------------- & -------------------------------------- ---- I -- ------ t --- --- -------- - --- --------------- --------------------------------------------------- -- - ------------------------------------------------- ------------------- -------------------------------- _ 41. ------------------------ I ---------------------- ------------------------------ --------- --------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:------- Date--------------- - --------- - ----------- 10"o SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfroc+ Stockton, California Lodi, California Manteca, California Tracy, California ES ----9--2M - ' Revised 1.57 F-P.CO.