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FQR OFFICE USE: -- -------------------- ------------------A ----?.--� -1 ___ ------------- APPLICATION FOR SANITATION PERMIT Permit No. ./ ar�w+r - ---------- ------------ ------------------- (Complete in Duplicate) 46 ----------------- This Permit Expires 1 Year From Date Issued bate Issued __.��.,2,; JV 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 ND LOCATION--------Alta_4-----------( ---- --- - - ��'� . - ----- ..------ --- Owner's Name--- S']-I ,y4 N----•--•F_Y'. -- 1*a�--------•----------- -------------------------------------------- Phone----••------------------------- rr Address----•--•----•-------l Contractor's Name-------- .......t C =--------•-----------------------------------------------------------•------ Phone.. ------- Installation Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A----- Number of bedrooms ----`-Number of baths A ---- Lot size .----��-------k- -------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 60 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------,........) No9 New Construction: Yes E] No [ FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: F (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' i Septic Tank: Distance from nearest well-----------------Distance from foundation----------------._.Material-__________.._____.____-_.__________._._.-_-_._. ❑ � No. of compartments--------------------------Size-------•------------------------Liquid depth----------------- ------_Capacity--•-------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation----------------.--- Distance to nearest lot line----------------- 0 Number of lines-----------------------------------Length of each line--------------- --------------Width of trench.---- Type of filter material-------------------------Depth of filte aterial---__-__-__--_---_-_:_Total length_---..-_-----___-__--_-_----_-------_-_-__ See age Pi Distance to nearest well 1p-!41_ ___._Distane fro founda 'on----i6_._._..Distance to nearest lot lire-�----_-.__ Number of pits--------I-.-----.- Linin material_.- :__��S e: Diameter._._-_ Lining Depth Cesspool: Distance from nearest well-----------------Distance from foundation----_----___-__.-_.Lining material-------------:..__-___-._ ❑ Size: Diameter------ -------------------------------Depth------ ---------------_--==--_ -- -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------______-___-___ A ❑ Distance to nearest lot line----------- ------- Remodeling and/or repairing (describe):--------l--i44--------1-.x---------- -rLr,---------- 1--•---------- --------------------------- ---- I [ ------•-•--- a ---- -----------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------•-------------------------------------- I ----------------------- -- ------------------------•----------------------------------•-----•----------------- -------------------------------- ---------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and rules and regulations of the San Joaquin Local Health District. (Signed) i�� ------------------- --- --------------------- caner and/or Contractor) �3 BY= -••----`-'!--.----- - - ----- ------ -•-------------------------------------------(Title)------------ - --- ------ -----------.. .- ------------ (Plot plan, showing size of lot, location of s tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- DATE -- �� REVIEWED BY------------------------------------- ----------------------------------------_---------- --- DATE-------- ---------------------------- BUILDlNG PERMIT ISSUED ------------------------------------------ ,------- --------- DATE--------- ---------------------------------- Alterations and/or recommendations:--_------� ___ .- :---_---. .-_ t�z- „� \ -- ----- =`-- - FINAL INSPECTION BY:.._,C/[ --------- - ---- ------ Date--.------ .o AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 PEWS= 8-59 3M 3-•63 P,P,CC.