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APPLICATION FOR SANITATION PERMIT Permit No. 33/ (Complete in Duplicate) Date Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work herwn delcribad. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.....244y_.Y....:A.11fl21]..,Way.............................................._......_._».»..».»........ Owner's Name..........awn..Ho over.................................................................. .. ...................................... Address......................s =,................................................................................».......................... ...»_._..» .. .. ».. ContractorsName.................:?.?1.'..a.........................................................................................................._». Phone_._. Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel U Other ❑ Number of living units: ----I.. Number of bedrooms Number of baths ....1. Lot sizeWater Supply:Supply: Public system ❑ Community system ❑ Private ® Depth to Water TaW 25— ft. Character of soil to a depth of 3 fest: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe M Hardpan Q Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No rL) TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well...... .Distance from foundation................. Material....... .... ZXISol:;G No. of compartments........................ .Size..............................–Liquid depth..........................Capacity....». � Disposal Field: Distance from nearest well.............. ..Distance from foundation....................Distance to neewvst lof line»_ 1:XISnNG Number of lines...................................Length of each line..............................Width of trench_.» Type of filter materiel.........................Depth of filter material...................»..Total length Seepage Pit: Distance to nearest well.100............Distance from foundafion.._U.'_..».Distance to nearest lot iinef_..5 L____ ❑ Number of pits.......1............Lining material...hr1Ck.....Size: Diameter......»..'„I.�.......Depth...»../..1....... Cesspool: Distance from nearest well.................Distance from foundation..................Lining material.... _».. UN ❑ .....Li Pse fLiquid Ca i Size: Diameter.......................... .. ........Depth............................................... q y...__....,........_.._... Privy: Distance from nearest well.................................. ..............Distance from nearest building................. ...... ❑ Distance to nearest lot line.......................... ..............................................................»_»_...».».....-........».».-........._...._ Remodeling an;!/or repairing (describe):.......Ver.tlml.................... .........._.._.............................................................................................................................................................._._»» ..».. ......».......... _.. -•........................................................................_.._........................................._.._.... ..............__..................... » _. ....»... ....»...._.__. ........................................................................................................................................................................................_................................... I hereby certify that I have prepared this application 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. (signed)--...Delt's............................................................. .._. _ .. I ... .......... ........... ...... . .... ...... ... ......(Owner and/or Centractor) By:............... ......... ...................... .. ......................................(Title).......CrcaeriMar......................... ...p�. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side} \ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. . �� -:��—.--..................... DATE........�..... ...� REVIE\ArED BY...._ ...... ..... ... DATE...................». .........................._....... D�_�,��.�.pz' .,,..;� ......... ^.... ........ ..3... .... �.BUILDING PERMIT ISSUEDL.., /rTE.. ......................;,zrt:! ............... ...... Alterations and/or rocammanda+iofs'/� _'.�..vx s.i.,. c.... �.,L, ...... c�(.....yet_"71.'...V.A�s�f.. .......;..t.+rL.S.../.(>.-.1. ...5� ........................ .. . .. ...... .. .. ...... ............ ....................................................................... ................................... ................................................................ .. .... ................................... ..................................................................................................... ...................................................................................................................... ..................................... .. .. .................................................................................................................................................................... FINALINSPECTION BY:.................. ..................................L.......... Date.............................................................................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strati 132 Sycamore Shots 814 North "C"Str..t Sfockfon, California Lc', Callornis Mamtoca, Califomis Tracy, Caliiersde ES-9-2M 8-51 R";sed W-2100