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FOR OFf ICE USE: ` ---------------------------------- APPLICATION FOR SANITATION PERMI ermit No. (Complete in Duplicate) —YY aa __________________________._..__._--------_------------- This Permit Expires 1'Year From Date Issued ed- !!1. ---- 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. 54,9. JOB ADDRESS A L CATIO Z-_9�___ __ :___.__: � ---_______ -- _ = '•--- . Owner's Name AUL hone ------ -- ----------------------------------- - Address y ---`->r 4 ._ -�...- -- -------.. •--------- Contractor's Name--.___._ ___-- -- z-----, `---,C__�_-----� - - k Phone----------------------------------- Installation will serve: Residence Apartment House [3 Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .----- Number of bedrooms- Number of aths`___ Lot size ______________'____-.____ Water Supply: Public-system El Community system El Private Depth to Water Table -------- 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 ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: E (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material---------------.----------------_-------__._-___. ❑ No. of compartments------------ -------------Size---------------•-------•--------Liquid depth-------------- ---------._Capacity----------------------- i field: Distance from nearest well---�f_.._'/._Distance from foundation__ s�_f-__-__.Distance to nearest lot I�te._ Disposal - - � -- Number of lines______ ______________________Length of each line__z5__.0______ Width of trench-----Z----- Type of filter material-, _�_�___ --------Depth of filter material---_- T------------Total length_____� '�----------- —: Seepage Pit: Distance to nearest well----------------------Distance from foundation...........---------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material-------- ------...Size: Diameter------------.----------Depth----_---------------.-----_- � 1 Cesspool: Distance from nearest well_________________Distance from foundation-------------------- Lining material__._._-_________._____.____________:. n ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------- Privy: Distance from nearest well ____________________________________------------Distance from nearest building lk� ❑ Distance to nearest lot line-------------------------------------------------------- ----- Remodeling and/or repairing (describe):_____._.4 1____________________________ _______ t ________________________________________________________________________________________________•_..._____________________________________.-»____..______________--______-_-___-__,._______._.________________________._..____ / _______________________________________________________________________________________________________________________________________________________________________________ ___________._____-____.__________.-_._..___ I hereby certify that I haCation d this application:an hat the work will be done in- cordance with,San Joaquin County ' ordinances, State laws,,and ruulations of the SJoa uin Local Health District.' - tp (Signed)-.------------------------------•------ -_----- ------------------------- By: ---------- -----• 0 ler-aad/° Contractor).- . 3 - f r B �' = -------------------------------------------- (Title)— Plo+ Ian, showing size of lot, s stem in relation o wells, buildin , esu tc., can be faced on reverse side).( P 9Y 9 P „ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --�� DATE p6 � REVIEWED BY------------------------- -- ------ -------------- - - ------- DATE-----------------------I ------------ BUILDINGPERMIT ISSUED---- ------------------------------ ------------------------------------------------------------ DATE--------------------------------------------------------- -- Alterations and/or recommendations----------------------- ---------- -- --------------------------------------------------------------_--------------------------- - - -------------------------- E FINAL INSPECTION BY:... -------- Y ------ Date-----------------------`--------I-------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stocklon,California Lodi,California Manteca,California Tracy,California ES 9 REVISCO 8-S9 3M 3-•63 f.P.CC.