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FOR OFFICE USE: --------------- - -- ------------------------- r X11' APPLICATION FOR SANITATION PERMIT Permit No. .-I-.77.2-4- --------------------------------------------------------- - ---------- ---------------------- --- - -- ------------ (Complete in Duplicate) 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 cons rruc at nd i�a t e w r herein described. This application is made in N ompliance wit4 County Ordinance No. 549. AXJOB ADDRESS ANQ CATION... . `� �1(,�.��/ .. - � ..._.. _ f --------------- Owner's Name ____ ------------------- - - -L__V EP__� .� ---------- ---- ------ ---- Phone-------------------------------- ._. . � -- -- r Address......--/dam A? _ ----------------•--LA am-------CR_M-P---'-------------------------------------------------------------- Contractor's Name----- = - -----•--- =---•------------------------------=-------------------- ---------------------------- Phone-----------_ --------------------- Installation will serve: Resi ante ❑ Apartment House ❑ Comm ial ❑ Trailer Court ❑ Motel ❑ Other �' . -------------------------------- Number of living units- _ __ Number of bedrooms er of baths __ _ Lot size _ Water Supply: Public syst�m ❑ C#mmunity system ❑ Private Depth to Water Table f�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made-, (If yes,ddte___------------t..__l No New Construction: Yes ❑ No E3/FFiA/VA: Yes ❑ No C-- TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or.cesspool permitted,if public sewer is available within 200 feet.}71 7 , d Se tib Tank:v Distan it from nearest well___.__.+_._______Distance from foundatiZL_on____________________Material A5 I No. of,,compartments--------------------------Size------------------ ----•- ------Liquid depth * I depth----------------- Capacity ------------•- --f-- --•_�Disposal Field: from nearest well..&.FkDistance from foundaftion/4------Distance to nearest lot line- ________ C a ,W.Itf Number of lines--------,9...../-- Length of each linelgNP..--.. of french--..Z-/------------------------ IIA ti 'IT of filter material,! __ Depth of filter material---- ._________Total length'_.c'` _____ _____________._ I � Seepage Pit: - Distandle to nearest well----------------------Distance from foundation_______..._.______.Distance to nearest lot line._- ❑ Numb 4p of pifs----------------------Lining material-----------------------Size: Diameter------------.----.-----Depth-----------------.----_---------- trr Cesspool: 6stance from nearest well_/---------------Distance from foundation----------_---------Lining material__._'_�__-_`___I___.____________ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity...... -----------------._..gals. f ' Privy: --�Disfanca from nearest well---------------------------------------------- from nearest building._____-__-_-_:_ ----------------------- , ❑ Distancee to nearest lot line----- - -------------------------------------•------------ ----------- Remodeling and/or repairing (describe)________________ _ � r -----------•--------------------------------- ---------------•------------•------------------------------------=----------------------- ---------------------------------------------------------------------------------- ---------------------------•- ----- - 11. --------------------------------------------------------------------------------- --------- --------------------------------------------- - --� - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- ----Q' 1 hereby certify,,:that lllhave 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. (Signed) - f ��" ---------- ---------- - -------------------------------- (OWrier and/or Contractor) Plot plan, showing size of lot, location of:s stem ' ation.to wells..buildi- ___._ - -- ( } -i By� _ = _ ( P g y rigs, etc., can be placed on reverse -side). 4 f 'IP FOR DEPARTMENT USE ONLY F0 _/JA - k L?`_`�` '� _ DATE--- - I APPLICATION ACCEPTED BY-- i �C - _7rO ` - � � (�. : REVIEWED BY---------------------------- - DATE-------------- ----------------- =-------------- f BUILDING PERMIT ISSUED: =w_�----- . - DATE --•------------------------= } ; Alterations and/or r commendattans-.' _' _� --------F ...---�A ' ------ L -----�!/ ------ /11_T��. �-`y: 'CAMP 1- (__,__ _ Fido M N11� 4 r 1/f}�-f I R P ------- 5 lCl ST1 nl _ '� _ATF SAS ---- ou .r _ tr__ :�--_ 1`� _`/s _'-�-_ _AD _7r!. -------1. ----1-1-^4f 1/II T -4' - .---------- .t_: ._ -_.-. �_I✓RS hr .,r` As 1r .D _:.. MF-�x 1_ ` _ ;----.-----T�-T ------------------- -----------------------___ ___----------------------------------------------------._-__.------------------- --- r 1l1jJTk-t '' " � �LL ' l � FINAL INSPECTION BY':...__...-i - - - ------------------------------------------- Date--- - ------------_-- -- _- ------------------------=-------------------- SAN JOAQUIN LOCAL. HEALTH DISTRICT i 1601 E.Ma:elron Ave: 300 West Oak Street . 724 Sycamore Street 2D5 West 4th Street - - t i Stockton,California) Lodi,California Manlecka Califinia_ Tracy,California ES 9�REVISED 6-59 3M 3-'63 F.P.CD. p