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pa u APPLICATION FOR SANITATION PERMIT Permit No. .� _.. (Complete in Duplicate) Date Issued .3. 11) This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here''described. This application is made in compliance with County Ordinance No. 549. -JOB ADDRESS AND LOC TION.. y -°� -.�r..... ... /ZA1ru- --................ �/- -... ..Owner's Name............�---X.T.Iv-- --- -_.f d -- � ---------- Phone..l`.Y9- _ .7 a2 r. Address.----...---........... -- // Contractor's Name....................... - - (! /114!�:�..._----- Phone........... 1.._................ Installation will serve: Residence Ape ment House ❑ Commercial ❑ Trailer �! K Motel ❑ Othe'r �] / Number of living units: .... Number of bedrooms ._f.. Number of baths I... Lot size ---..-7�r �............. 1 Water Supply: Public system X Community system ❑ Private ❑ Depth to Wafter Table ........ it, Character of soil to a depth of 3 feet: Sand ❑, Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No'o,, FHA/VAo Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (Ne septic tank or cesspool permitted if public sewer is available within 200 feet.) ' 'If Distance from nearest well................Distance from foundation.....................Material........................... No. of compartments.................._......Size................._...--.,-.---Liquid depth............._.--------..Capacity------------------ i I I Distance from nearest well............_-_Distance from foundation....................Distance to nearest lot Ilne................. Number of lines-_i_-----------------------------Length of each line..............................Width of french..........__L................... Type of filter material.........................Depth of filter material.......................Total length.....................)_........._......... — eepage Pit: Distance to nearest well......................Distance from foundation..__.--__--------.Did ante to nearest lot Iiia............_... 7_1 Number of pits....'.................Lining material..............._.------Size: Diameter.,'..:...............Depth......__... ._................ L 1 Cesspool: Distance from nearest well.................Distance from foundation....................Lining material-------------- ............____.... 171 Size: Diameter--:�-------.....................Depth................-.................................Liquid Capacity.............---....:......gals. n' Privy: Distance from nearest well-............................_...............L..Disfance from nearest building.........-----------_----...._..___-._...Distance to \ estlot line...........____............................:..._.............__._._.._._..__...._............---....__.......... .................... Remodeling and/or repairing (descrl _._........—..................--...... ................ .. ..... ............. . r ♦ .. .:p........ ............. .. .._...___._,.._.1......_.... ---------- .___.. ....................... ._____.._.............._.....__..........:_......__........i.........___..... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfl ordinances, State laws, a d-rupleessanand_regulations of,the San Joaquin Local Health District, (Signed). ... ------.........................._.. ----...._.--•'a-~----- ...................(OwnerA6d/o Contractor, ..t itla By----------......_.... - - - -.._.._..... --ff 1 - - - ..... ,- (Plot plan, showing size of lot, location of system in relation to wells, buildings, eta, can be placed an reverse side). -r FOI DEPARTMENT USE ONLY CC - APPLICATION ACCEPTED BY.. - DATE..-.........'..j.3-=------ --------------- REVIEWEDBY............... - --- - r ............- :... ................... DATE.............. .......(..................... BUILDING PERMIT ISSUED._..--------'----------------------•- ----.__.._•••------------ _ ...._.....- DATE.................................. -............... Alteratio nd or recommendations ....... ...�.... .-,.. .............- - ..._. ........ ...- �. ..... ----- - ----..................................................-------_-_ ... .....................--------------- ..... .------- ..... ....................................... ---- ...................:.............................------..... . ............ ..............._............ .......-----.........j.. -................ r, FINAL INSPECTION BY: _..... --- - Date........l.l.�.. ..�t.Q...................1 --- SAN JOAQUIN LOCAL HEALTH DISTRICT , 130 South American Sfreat 300 War+ Oak Street 132 Sycamore Street $14 Nooh "C" eat Stockton, California Led% CaRfomie Manbu, Califamie Tracy, Cdife� to