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v' APPLICATION FOR SANITATIPERMIT Permit No. _la.._�__�__z- [Complete in Duplicate), F �� 7 / 7 Date Issued ---------- ------------ € Z ' -`"`Application is hereby made to the San Joaquin Local Health District for a perm• onstruct afld install the work herein described. This application is made in compliance with County Ordinance No. 549. l �y c.N- QKEF-------I-AN�------------------------- ---------------------------------------- JOB ADDRESS AND LOCATION _______/_ ___ __________ Owner's Name LF—Phone_------------------ ` Address------ -------------- �. C _} .E-�------ _ F------------------------•------------------------•--•--•--------•------------------------ Contractor's Name--------•-----------------------`--:-----------------------------------------MF------:HANNLI __ Phone ----------------------------------- ---------------- Installation will -serve: Residence El Apartment House ❑ Commercial [] Trailer ourt ❑ Motel ❑ OtherK.--' Number of living units: -------- Number of bedrooms -------- Number of baths -------Lot size ---------- _------------------------------------------------- Water Supply: Public system Community system E]Private E]Depth to Water Table ________ ft. Character of soil to adepth of 3 feet:- Sand L❑ 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: %r (Noeptic ta4 or'cesspool permitted if public sewer is available within 200 feet.) ` k Septic Tank Distance from nearest well !A©_ �_ Distance from fou ;dation___j_0-_________-Material___- 1_�P_� OP -D--..________- No. of compartments.------�-------------Sizej`Z-- -- --- -Capacity a� Disposal Field: Distance from nearest -well__`.2Qp...... Distance from ,foundafiion___/�__-______Distance to nearest lot line__ -_ ____--__ Number of lines ---------- I ------------------------ Length of each line____o66_--r Width of trench ------- — ._-----:------------ �- r Tyipe of filter material- CK --------Depth of filtrle� material____.l�______.___Total length___________•__________ ____________ �� Seepage Pit: .Distance to nearest well ----- _---------------- Distancefcom foundation ____�.,_�....,,__.Distance to nearest lot line ----------------- El Number of pits- --------------------- Lining material -=-----------------.Size: Diameter--. ----------- --------- Depth -_----,t.=�_,::= -. !~ Cesspool: Distance from -nearest well ----------------- Distance from foundation__."___^' --------- .Lining material ___________________________________- ❑ Size: Diameter- ------------------------ -- - Depth-----------------------------------i=----------Liquid Capacity ------------------------ -gals. Privy: Distance from nearest well ------- _----------- ___ ----- _-------- .___ .----Distance from nearest building ------------------------------ ------_-_-_. ❑ Distance to nearest lot line --------------------------------- --------- --------------------------------------------------------------------------------------------- Remodeling ------------ ------------------------Remodeling anti/or* repairing (descriL�e]: &---------------------•------------------------------------------ -----•------------------------------------------------------------------------- -A - I hereby certify that I have prepared this epication and that the work will be done -in accordance with San.Joaquin County ordinances, State laws, and rules ancL regulations ofjhe San Joaquin Local Health District. (Signed) ! ___.___----(Owner and/or Contractor] -------------------------------------(Title)----------------------------------------------- ---------------- (Plot plan, showing size of to , ocation of system in re a ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT,USE ONLY F-- ��---------------------------- APPLICATION ACCEPTED BY ------- -'-�'P'-------------------------------- -----•---------------------- ------ DATE------ REVIEWED BY------------------------------------------------------------ --------------------------------------------------- DATE---------------------------------- - - ---------------------- BUILDINGPERMIT ISSUED -------------------------------------------------------------- -------------------- •------- = =y----- DATE ------------------------------------------------------------- Alferafions'and/or recommendations:__8/4/64.:------- This__-apparmtly--is-_ink=-and--Won-king-.--_--- know---about__a.:L._-----�_t£)----------_-------------------------- ------------------------------------------------------------------------------------------------- ------------------------------------- !------ ...-------------------------------------------------------------------------------------------------- ------------- ----------------------------- .--------------------- .------------ ----------------------------------------------------- _----------------------------------------------- _-------- _----------------------- ._.. __y _:_?.______-__-______-___.____._______--____...__________.___ FINALINSPECTION BY------------ ---------•-------------------------- -------------- - Date.-.--------------------------------------- -----...----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M Revised 1.57 F-P.CO_