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OFFICE USE: �J ---------------- �Q --- --- -------- -------- ---- - Permit Na. _�L`•-f`�-._41-� ------------------- APPLICATION FOR SANITATION PERMIT [Complete in Duplicated C ---- ------------------------ - -------- ------�--- ---- ----- --- --- ---- 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 install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------------------------------------------- �-- 3 �-----r •- -- --------------- -Al, ka - - -- -------- Phone_a'-J-�3-7- -------- Owner's Name._.��r��_�.�h ---•}�---�u!•-/('�'--•-•------------------------------ ----------- ---------- ----- - Address .-i- Alyl A h 7--e.c 415 -------------------------------------------------------------------------- --------------•--------- L --•----------- --------------- /f' -------- Phone---Y AJT-�r---� -------- c Contractor's Name____p_..____�_____-�_. - Installation will serve: Residence ®" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _L__.. Number of bedrooms -3____ Number of baths __4__ Lot size __._:�___._ U ---------------------------- Water Supply: Public system ElCommunity system ❑ Private Depth to Water Table -----_24. ft. Character of soil to a depth of 3 feet: Sand ®' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date....................) No Ij" New Construction: Yes ®- No ❑ FHA/VA: YesNo ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: -�(No�sep+ic#ank-or cesspool-permittedTif-public-sewer-is=available-wi+hin�204 feet:)— F. z , - i . e_ _ _..___.. Septic Tank: Distance from nearest welL_S�__._______Distance�ro _-_ � ___-__. G .___-_ z" e�� foundation---Liquid depth----- ----------.Ca accty.. ��-� - No. of compartments - z - - --- � Disposal Field: Distance from nearest well--.3-0-_--_.-Distance from foundation-__Ie_-�.____.Qist�nce to nearest lot line ______.... f Number of lines-------- --�---------------------Length of each line------7._`F.1----- -------Width of trench---- `-------------------------- a ` Type of filter material---I __--4__<-'------Depth of filter material-----tf----------Total length------__.s__-------------- -- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits-:-- ------._----Lining material-------------- ---------Size: Diameter-----------------------Depth---------- --.`.r Cesspool: Distance from nearest weil-----------------Distance from foundation ------------------ Lining material--------- __-___.ls. Size: Diameter- ----------- ---- ----- -------- th_------ --------------------------- -------------Liquid Capacity ------------------- gals. ❑�_ - Privy: Distance 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 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. �� -------- ----------------------- -(Owner and/or Contractor) (Signed)-------tom" '-�- ---��--.�`'"`----'----'------------- ----- ----- --- -------- ------------ ----- ----- ----- - -=------(Tltl ----------------==---------- --- ------ = -------- f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. FOR-DEPA ENT USE ONLY ` APPLICATION ACCEPTED BY__.__ =-. _�- -- --------------------- -- DATE------..- 3-_14I�..7-67—----------------- REVIEWED BY------------------------- ----- DATE ;' BUILDINGPERMIT ISSUED--------------------------------------------------------------- ----------- DATE---------- ----------------------------------------------- € Alterations and/or recommendations--------------- ------- ---------------- -------------------------------------------------------------•---•--- --------•---•---------------------- --- -- ------ ................ ---------------------- --------------------------------------------- I ------------------------------------------•------------------------------------;----- ------------------------------------- ----------- E •---------•---- ------------------ ----- -------_ - --- -------------------------------.-------------------------------------- ._ ---- -------- --- --- ----- ------------------------------------- ------- ----------- LDate---------- �. �_--`-- -'- r--------- -- ------------ FINAL INSPECTI .---- _' +� P 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i F.P.CC. .