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"00' FOR OFFICE USE: - ----------------- _�.3_ -&—ct___ - --- - --J- APPLICATION FOR SANITATION PERMIT Permit No. .-!.._ (Complete in Duplicate) ----- This Permit Expires I Year From Date IssuedDate 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. JOB ADDRESS AND LOCATION----- r--- Bak--_�SiO___4,fwaz ----- zi-- r"--Qrdl,,fl Owner's Name AT-. '111 Cwt 1"Z -ee --------------------------------------- Phone- fj ---• Address--------------------- ' �P,LAS 77,il�--------------- Contractor's Name--------- _ ------------------------------------------- -------- Phone_l-W11---1�..0�0-�--•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: __ .____ Number of bedrooms -.-- Number of baths ---/__ Lot size Water Supply: Public system ❑ Commbnity system ❑ Private [ Depth to Water Table _4.E9 ft. Character of soil to a depth of 3 feet: `Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam a Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------- Nog New Construction: Yes ❑ Noo FHA/VA: Yes ❑ No X h ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.). Septic Tank: 'Distance from nearest well_' 7Q--- 11 e __ Distance from foundation__ ?_______ _. Material.___- .�z ''`_ ., ----- r .. .r No, of compartments_. ._...__�`._______Size__��_�X� .---Liquid depth____ Disposal Field: Distance from nearest well_-_.50-____Distance from foundation-----/0____.._-Distance to nearest lot line-----4________ Number of lines_____________ _ __ Length of each line------�e---_-----------Width of french_.__�_.�_' .______._ ' i. Type of filter m-terial___ _ G°/C'_Depth of filter material-___./t_._______-Total length_-- - ��------------ Seepage Pit: Distance to nearest wO--- 1_�._____Distance fro foundation-_ __-___-_. �� Distance to nearest lot line__.--__--_ -Number of pits------ __------ __-Lining mate rialSize: Diamefer.__"Y7..9-_.-__.Depth----- --f_____________ Cesspool: { Distance from nearest well--------------.__Distance from foundation---------_----------Lining material-_.--_____-___-___-._..____-__-.--__ ❑ - Size: Diameter------------------------------ -------Depth---------------------------------------------------Liquid Capacity- --------------------gals. ' Privy: Distance from nearest w1.ell----------------------- ------------ --------- 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 regu s of.the San Joaquin Local Health District. (Signed) CL C: E a �` --- ---- ----------------------------------------------------- ------------ w r and/or Contractor) k BY E -G• ----(Title) ---------- --------- (Plot plan, showing si of lot, location system in relation to wells, buildings, etc., can,be placed on reverse side). FOR DEPARTMENT USE ONLY 4 . j el— APPLICATION ACCEPTED BY--------- .- ` DATE ` J' l- ' REVIEWED BY DATE ---------------- BUILDINGPERMIT ISSUED------------------------------------- ------------•------------- ------- -------- DATE-------------;-----_-------- ------ -- .- ------------ f Alterations and/or recommendations:-_._--..__- / 13` -- -�`�`=` -` �`-tib' . — ----------I-- ------._ .� Z---- / �t�—'z t !-- -- r �� -/ 7 i �� ` "7 + .��” ---- -------------- -`--�- —`- �- 4{ ------ FINAL INSPECTION BY:-___- ',---_ / = 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California _ F.P.Cq. k