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APPLICATION FOR SANITATION PERMIT �r►��Pe�Jrmit No. _�a l Z (Complete in Duplicate) -� +o ( i This Permit Ex ires i Year From Date Issued k;42 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 County Ordinance No. 549. JOB ADDRESS AND LOCATION_.._.py ---------------------------------------------------------- Own er s -------------•------------------------ ------- Owners Name. -4- A.anl' --.---.11-B-' - '•• I'..11_llt.h.------.. ..�.�--- �► �7_ f, _ J cd...�lf Phone.------------------------ ----•.... 4 Address-------�::. .-•'-s�-_�--•1�-•--•--....__....'.-----pp------��-rr-------•----•---------------•--•_-•_._._....._----------•---•-•---------......-----------------------•--•--•-------------------------------•---• Contractor's Name ---------�?_._�[_..l..-------------•----........•........................... --------------------•------- Phone---------.---------------••-----•- Installation will serve: Residence ❑ Apar+ment House ❑ Commercial ❑ Trailer Court U?_<ctel ❑ Other ❑ 1 Number of living units: _47- Number of bedrooms Number of baths ...�-. Lot size .......... _---- ._..._...._________.-_ _............... Water Supply: Public system ❑ Community system ❑ Private F-tepth to Water Table 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 ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �j �. / / Septic Tank: Distance from nearest well_._��__._�Distance fVom fo ndatiPPn.....1a. rpe�i91...__ .'�a�7-..... .... -, -_- (� No. of compartments.--.-,,-?,.__...�,-Size y. rO� Liquid de�h___h 2...:............Capacity-_- Disposal Field: Distance from nearest well---�/..Distance from foundation-._--A4_. 4.Distance to nearest lot line----- , . � Number of lines _______)02.-....._.----.---- Length of each line--------------��-_.---..Width of trench..-------c�_..._...----•--••-_- Type of filter material_.. �z ..Depth of filter material..._._/,7A-/.._Total length........ Ct . Seepage Pit: Distance to nearest well__ 1. Distance from f ndation.....j Ct_ Distan�re to nearest lot line.... Number of pits..a_... '�.------Lining material_ _. le, Size: Diameter... ........Depth........ ............. Cesspool: Distance from nearest well-----------------Distance from foundation. _ .___.Lining material...................................... N, ❑ Size: Diameter.--,.,,.-----------------------------..Deth.--_.-----------------------------------------------Liquid Capacity Privy: Distance from nearest well----------------------------------------•-------•Distance from nearest building.......................................... ❑ Distance to nearest lot line....................................................................... t Remodeling and/or repairing (describe):...................... ---------------------------•.....----......------------------•-----•-•--••---•-......_..._........---••-............. `Y+ I 1 ............. --- --- ------------------------------•---------------------.... --------------------------------•------- - . ...------------•--•-- ----- .......................... f I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County _ ordinances, Stat laws, a rules and regulations of the San Joaquin Local Health District. (Signed)_. � --------------------------------------- .. ------------------------------------------------------------.._..... ....(Owner end/or Contractor) BY - ' -- --------------------(Title)..... ...--_-. - y--- _._---------._........ ...................................... (Plot plan, sho m size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). EPART T E ONLY APPLICATION ACCEPTED BY... - - - ------- -- ------------------------ DATE.------- REVIEWEDBY- ---------- --------------------------------- ------------------------. ............................ DATE----- -------------------- BUILDING ---------BUILDING PERMIT ISSUED-------------- -------- ...................---•-----.......---•------ ....._--_- .. .. DATE...--------------------- Alterations ..--•---------•---Alterations and/or recommendations:------------------------ -------------- ;; - •............ -_ ----- - l -------•-••-•--••••----... .......................... ----• .•--••----•-------------- ------------ -------------- -- - -----------------•---------------------- ------------------------------- --------------------------.- ..... .......................... ..................... FINAL INSPECTION BY:.... ........ . Date.- a.�[ ....fes-�S............. SAN JOAQUIN LOCAL HEALTH DISTRI 130 South American Street 300 West Oak Streot 132 Sycamore Street 814 North "C" Street Stockton, California I Lodi, California Manteca, California Tracy, California ES-9-2M wRe�ited 8-'59 F.P.Co.