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Y APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) / Date Issued 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 herein described. This application is made in compliance with Co my Ordinance No. 549. JOB ADDRESS AND LOCATION------ -- ----------- '� J 7------ �'`� -------.•--------------•--------------------------------- Owner's Name -- _ Phone --------- X4,4— . . / - --------- Address-------------•-•-------------�///��_.€ 7/7��U�,. J---I— � Contractor's Name---------------I/`�-- -� �? ---------------•------------------•------------•--------•-•-----------------._...-- Phone---------------------------------- Installation will serve Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ElNumber of living units: Number of bedrooms .,-3-- Number of baths I---- Lot size __ /1 ---'"-------------------------- -- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table Character of soil toga depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe l ardpan ❑ Previous Application Made: Yes ❑ No a-- New Construction: Yes B-�No ❑ FHA/VA: Yes 9� No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic k: Distance from nearest well___-_ _ '---Distance_f om foundation--- -~1 Mate�aL �R �a ------ = © No. of compartments______-_ -----------Size__ - 'L� j1------Liquid depth-----�2-----------Capacity----S. p-------- Disposal Field: `Distance from neare st well -.-------Distance from foundation----Z�_-r.-_.Distance to nearest lot line___-4� ®� Number of lines-_f ----- - :_---_�'Lerigtli of each linea , U -0 P_Width of trench. �`- -fir _.--------- aL_/ ��,�.Depth of filter matenai_ i`_---- Total length____- -- •�--------- ,.Type of filter maters f / Seepage Pit: Distance to nearest 'well------- _.____Distance fpm foundation____144____f- Distance to nearest lot lin_e__.C�--------- K .;Number of pits._._:_-a�---------Lining material__��tl�..Size: Diameter._, --------------Depth__�s� Cesspool: 'Distance from nearest well------------------Distance from foundation--.-----------G-----Lining material-____.._____--_- .___--------------- "Size: ______-______-'Size: Diamete.r--------------------------------------Depth---------------------------------------------_--._Liquid Capacity----------------- ---------gals. Privy: t,,istance from nearest well-------------------------------------------------Distance from nearest building.____.__________- 'Distance to nearest lot line---------------------------------------------------------------------- `= - Remodeling and/or/repairing (describe)=.----------- - � '.._. ". -----------------------------• -------------------- --------- --- ---- --------------------------------------•---•-•--- ----•---------------------•---------------------------------=-------------•---------------•------------------------------------------------------------- ----------------- -----=--=----------- ----------------------------------------------- -----------------•----------------------•-------------------------------`-------------------------------- I hereby certify that I have prepared this applicatioql and that the work will be done in accordance with San Joaquin County ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. I Si ned ------ ------- . .. .. 4 ......... �-- ;`h�or Contractor) By:---- --------------- ----------------------------------------- (Plot --••-------------------------�-�� `�� tc. can(bele)laced o� _ ___ (Plot plan, showing sae of lot, location of syste relation to wells, buildings, p reverse side). FOR-DEPARTMENT USE ONLY T r-------------- DATE...- APPLICATION ACCEPTED BY----�1- �-`Q-�- -- ---`---------------------'---= •� �,1.)-`y--�- r"------- -- --------------�-� i REVIEWED BY - r ----------------- =-------===--DATE—�. ---------------------- ---------_-------- �--- - ---- --� ----{� .. 1..1 BUILDING PERMIT ISSUED-!!`�^----------= ---------------------------- ---------------- Alterations - ----------- DATE. - - Alterations and/or recommendations:---'-•-!------------------- ;-------------------------------------------------- ------------- -------------------------,--------------------------------- ------------- ------- -----Ater-- Ah�L�' - `� - --------------------` ---------------------- ._ - ------------------------------------------------------------------- -- l ----------------------------------------------------------------------- -------------------- 1 ------------------- ----------- --- --------------------- _. FINAL INSPECTION -�- --- --- - --- Date. / �'--/r. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streat 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California —... — Manteca, California Tracy, California B-9-2M Revised V59 F.P,Co.