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APPLICATION FOR SANITATION PERMIT Permit No. (Complete In Duplicate) This Permit Expires I Year From Date Issued Date Issued .�kI6..Irll Application is hereby made to the,San Joaquin Local Haalfh District for a permit to construct and in I the work herein I describid. This application'is made in cornpIjanceftw4&unty Ordinance No 549. d� JOB ADDRESS AND L(?CATION........lig. Owner's Name........... . .......... ... .... -------------- trsr Address----------------- ------------- Phone................. ..... Contractor's Nam, •-------------------------•------•-•------....- --•-- .......;K--------- --------_---------------- ---------- ........... ----------_-----_ Pho I- I ft ----------------�x❑x9j. Installation will I serve- Residence C] AparfmenfHouse E] Commei;cial -------- of [] ( Number Trailer Court E] M Other of living units: ........ Number of bedrooms........ Number size ........ .... Water Supply; Pu I - of ....... Lot ......I......... blic sYsfemn Community system 0 Private Depth to Water1ab)6 Character" -j.pfh�- , 0( of soil to- 'of 3 feet: Sand El Gravel [] Sandy LoarN&<Clay Loam 0 Clay 0 Adobe Cj Hardpan ❑ Previous Application Made: Yes Lj 'No&( New Constructioh: Yes 0 No ❑ FHA/VA. Yes TYPE OF INSTALLATION AND SPECIFICATIONS: -1 .- — �rrniffed rif Public sewer Is available�vifhiin, 200 ieet) (No septic tank or.cosspoof'O 14, from founclafion-.-Ya!.............Mat Septic Tank- Distance from n.ear's * t at rial No. of compartme _.��. .7......-------4-4- Liquid depth...... a le M- ..............Capacify_'_JAVV�........ 646 1 R Id Dls;a_nce_fr, nearest'well 14M- Fsf'an' 4 from foundatiop_._1 _........Distance to nearest lobli *f each-line-.-- --- e Number of lines...-_ ff Lengfh-0 Width of trench_ ................. Type of filter material.�Z materid"L., ------ -Depth of filter I -.Total length--1 . ............................ Seepage Pit: Distance to nearest well...................:_Distanee from foundation. _____.......___._.Distance Number of pits.................... I............ -..Distance to nearest lot line................. Lining material.......................Size:Size.-fMameter......... Lining ...... Depth.t.............................. Cesspool- Distance from nearest well----------......Distance from foundation------_---------_Lining material.___........___._....__... . Size: Diameter......................................Depth-------------------------------- ------------�Liquid Capaci Privty------------------------_-gals. y: Distance from nearest well----------- Distance from nearest building......................................... 171 1 Distance to nearest lot 4n 1�*------------------**-------------*------------ RemodeJ; g an or repairing (describei)... --------- ---- I*1in ............. g an -- - ---------------- ... ....... ... n , - Remodeling ---...:_---••-••- .................... ................. _4 I-- - - ------- ------------- ............... ......... 4r -------- ----------------------- ---------- .............-1------------------- ------_-•--........._ ----------- I ----------------...............I... e..;or.iwill -------------------.............................................I................ in County I here y certify that I have prepared his applicaflon and that the ark will 69 done in accordance with San Joaquin ordinances. State 12�0%r an les an egu ations of the San Joaquin Local Health District. a, I lion�' (Signed).,.. i(--- �......... .. . ...............................*--------------*-----------*--------------_-------------(Owner and/or Contractor) BY:.......................................•......_. (T. .tie---I..................................-- ------------ (Plot Plan, showing size of lot, location of system in relaflon to wells, buildings, etc can be placed an reverse side). �FOR DE�PARTM7ENT USE ONLY APPLICATION ACCEPTED BY_______________________ DATE REVIEWEDBY'...................................• ----- -- ------------- ..........._1--------------- -----_--- DATE...... ...........---------------- . ....... DATE -------- ............................. - D T ------- BUILDING PERMIT IS,SUED............................ ---- ....................................... DATE------- ----- .............................. .................. --------------------...................................... A, F-...............•_.----......__..._._-...---._.._.. ...........*-------------------------....................*.................. DATE .......... Alterations and/or recommendations:_.-____ /--------------------------------------------------------------------------------------------------------------------I................... `-j�................. ---------------- ........... ...9 .......!?n.......... ........r4!t........................................................................................................... -------------------------------........-----------................................... ....................................... ................I.................................................. ...............................................--------I.......................... ................................ ...................................... -2, BY--------- tat Wrk-7",� FINAL INSPECTION -------I..........................4----------- Date_.... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore $free+ 014 North "C" Stockton, California Street Loai, California Manteca, California Tracy, California ES4-2M Reaised 8-•59 F.P.Co.