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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-----------'001---Alvarado .:,ve� bluoc .':on , cal. ------------------------------ Owner's Name Glen •-� W-�� .! - - - --- ------ Address------------- 40 711 e.l vGxad . va , J*0 al ------- --------- ----------------- . ---------------------------------------------------------------------------------------------------- ---- Contractors Name ---------- ' ------------------------------------------- ------------------------ Phone. ------ -—---------------- Installation will serve: Residence [2QApartment House [-] Commercial E] Trailer Court El Motel ❑ Other ❑ Number of living units: 7] Number of bedrooms 3] Number of baths A Lot size-----------I__-________--: Water Supply: Public system [❑ Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [21 Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well______6-2___Distance frmfoundation No. of compartmetil-- o-----__Capacity--� - ei1Cdre'Gpt�-ht----------------�_--:--- 'w_ _...___---` - --- s Cesspool: Distance from nearest well_________________Distance from foundation-----------------_Lining material--------------------------..___ ❑ Size: Diameter----------------------------------•--.Depth--------------------------------------------- --- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________.._ ❑ Distance to nearest lot Iine______.____________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line---------------__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------------------- Depth--------------------------------- Disposal Field: Distance from nearest well____~O_1-------Distance from foundation__-___ 0.1_--__.Distance to nearest lo� line_____L_ _______ ® Number of lines------ '- e ___ ___Length of each line__-_1 ✓D_! Width of trench___2-4-1- --------- 4'1__.__.._________________ Type of filter material____.i _-_____ _-Depth of filter material----1-2 1`-------------- ro Remodeling and/or repairing (describe)---------------__------------------------ -------------------------------------------------------------------- -------------------------------------------------- ----------------------------------------------------------------------------------- I hereby certify that I haveF)repared this application and that the work will be done in accordance with San Joaquin County ordinances, St la and rdlesregulations pf the San Joaquin Local Health District. (Signed)_ l� A__ ;� t t -.- �---= `- ___-. _ caner and/or Contractor) By- - F =�� 1 \ --------- ---------------- (Title __ t-'i 4 c x't tor) -------------------------------------- (Plot plans, showing size of lot, location of syAn in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- -"`=' >-------------------------I---------------------------------I------ DATE------ ------------------------------�� --------- - BY------ ----.-- -----------f --------------------------------- �f'.-� --- ------ DATE__--- ----F- - -- ---------------�------- BUILDING PERMIT ISSUED-------------------------------------`�_ c5i e =<.- - DATE - --------------- - ------------------------ A aerations and/or recommendations_______________________ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -----------------------I-------------- PERMIT No. ISSUED 1 ------------ ------(Date) FINAL INSPECTION BY:------V`1 J-. . - -- ------------------- f j) r Date--- ------------•'--'---�-- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W=1639 Stockton, California