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�� R OFFICE USE: '�� .. J / ' % APPLICATION FOR SANITATION PERMIT Permit No. .1.la._.._- ------------- --- -------- (Complete in Duplicate)--------- (Complete- � Date Issued _________ --._G ------------------------------_--_.--_--_-.___._-- --- This Permit Expires I Year From 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. t �� 0__1Z!2-------------------•-------------- JOB ADDRESS AND LOCATION......-•4-�-2 -�--------------- - -��--�-.�-� --------- ------------------------------------------------ Owner's Name = :-L..Q_i. - -----------------F_I.-rA_c__Ai----------------------------- ------------------------ Phone........----------------------••---- Address-------------------------- -----•---•-••--•----------------------------------------- -------------------•--•---•-----------------------...-----------------------------------.... Contractor's Name------------ ---Is,--�. ............11 C-A------------------------------•-•----------- --- --•------------- Phone-- -Q:.b.5.-b-Q'7---- Installation will serve: Residence T�k Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: Number of bedrooms .-3- Number of baths _-I---_ Lot size ____-----------/T_C_r7_!E-----------------_------ Water Supply: Public system ❑ Community system ❑ Private X'-.Depth to Water Table._Q_ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam [-] Clay Loam [:] Clay ❑ Adobe X Hardpan ❑ Previous Application Made: (If yes,date-_-----------------I No New Construction: Yes ❑ No` FHA/VA: Yes [] No,% TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well-----------------Distance from foundation---__________.___ ❑ -Materia!_____..__--_-._.--._-.---.--__---___---_----___-- No. of-compartments--------------------------Size--------- ---------,------------Liquid dh ... ept -------- -- ------------Capacity -------------------- Disposal Fie! : Distance from nearest well.__--------------'.Distance from foundation--------------------Distance to nearest lot line______:_--.___--_ ❑ Number of lines_____________ _-__----__I Length of each line-------------------------------Width of trench..-.__._.____:.___.--.---._.------- Type of filter material---------------------_---Depth of.filter material------------------. -Total length-:--•--.___-_:__-_______________-..___-__ Seepage Pit: Distance to nearest well---1-001--------Distance from foundation:____ _ t t�:..___.Distance to nearest lot line..-_40:0_ ' v-0 Number ofpits-------I---------- Lining mate -Q-1-1.---.Depth- ----------- Cesspool: material r Distance from nearest well-________________Distance from foundation._.__--____------.-.Lining material--.---_.__.----.---____.____--_____ ❑ Size: Diameter------------------ ------------------Depth----------------- ---- ------------Liquid Capacity------------------------._..gals. 09 Privy: ..= Distance from nearest well--------------------------------------------------Distance from nearest building_________________-__-__---------_.._. ❑ Distance to nearest lot line----------------------- ---------------------`----•---------=---------- --------------------- ----------- ---------------------------------- 4)F y Remodeling and'/or repairing (describe) F-� vS ------------`r as.-/ — ------------------------- ------------------••-- --------------------------------------------------------------------------------------•------------------------------------------=----- --------------------------------------------------------- --- --------------------------------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------- ---- OL ----------------------------------- --------- -------•----------------•-------------------•----------------------------------------------------------------------------------_------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la , and rules and regulations of the San Joaquin Local Health District. (Signed)------------------ --•------------- ---- (O net and/or Contractor) - . $Y: fCs: ---------- 0 4- --------------------•----(Title) (Piot plan, showing size of lot, location of s tem in tela+ion to wells, buildings, etc., can be placed on reverse side]. F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- Q-' C ------- -------------------------------------------------------- DATE---- -I = 4' ---------------------------- REVIEWEDBY------------i---------------------- ------- --------------------- ------------------------------------- ------------------ DATE------------------------------------------------- BUILDING PERMIT ISSUED---------------------------------=-------------------¢ ------------- ----- ----------------- DATE--------------------- o `Alterations and or rec ------- �-- � ---- .... L. ------ - = �SIf ----- --------------------= ------------------- �i ��--------------------------------- ------------------------------------------------------------ --------------------- ------- ------ -------------------------------------------------------=- --- ------------------------------------------- ---------------------- ---------------------- ------------------------------ FINAL INSPECTION BY:-.--C-,- Date -.1 ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-59 3M 3-'63 F.P.DD. LK a