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AFOROFFICE USE: -- APPLICATION FOR SANITATION PERMIT- . 7 ..---- - �,� Permit No. _.. � /. Z --- ------; {_t (Complete in Duplicate)- - This Permit Expires 1 Year from Date Issued 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. JOB ADDRESS AND LOCATION_. %{ =CI Owner's Name-----. Ili.l AkIlk _-__- --- Y= le!.fL�' _' - --- Phone_&_ _ -"*--7P7--- Address-----•----- a� Contractor's Name--------DI.- H------.f'1'�-k��_1.51� �. .�SoA,i......mv,- - ------------------- -•------ ---_. Phone__/�©_6-11�Ul------- Installation will serve: Residence Ey' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: ...._ Number of bedrooms _.72-- Number of baths -- -Lot size ------L�M......A!''.1e Water Supply: Public system ❑ Community system ❑ Private V 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 Er New Construction., Yes ❑ No ED-" FHA/VA: Yes ❑ No Fid 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_...............Distance from foundation----------------- Material--------------_------_--.----___._._...._____. ❑ No. of compartments------------- ----- -- -Size--------------------------------Liquid depth - - - -- ------------Capacity ---- --- --------- J Disposal Field: Distance from nearest well.................Distance from foundation-.___.____._.--....Distance to nearest lot line----------------. El Number of lines----------------------------- -----Lenth of each line------------------------------Width of trench-_.....________- r Type of filter material Depth of filter material---------------------.Total length------------------------------------------ Seepage -__________________ _Seepage Pi Distance to nearest well___-~/ .........Distance from foundation-------- Distance to nearest lot line.... rs a dumber of pits..---_---f----------Lining material__ .------Size: Diameter------ .. " J Cesspool: Distance from nearest well-----------------Distance from foundation .....Lining materiaf....__._......._..._._____.._..._____ ❑ Size: Diameter----------- -- -- ----- ----------Depth-..-.-..----- ...--- Liquid Capacity gals. .1 21 Privy: Distance from nearest well______________________ ..............Distance from nearest buifding----------_-------------- ❑ Distance to nearest lot line------ r Remodeling and/or repairing (describe):------r L?D -.- ex 14ZI-IN-0 -A u- y � = Lit= 7E�1�Gd1/ tt1_�J1!Z _ - ---- t---------ClYlc'.:4._.__ /i'_ '_L;/f_!_..._`_. !%-- - --.. --------------------- -------------------------------------------------------------------------------------------------------------------------------- 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 regulations of the San Joaquin Local Health District. (Signed) ----- t--------- _ .-�` _' <; _r. c..- ------------------------_----�-----(Owner and/or Contractor) Plot !an r showing size of lot, cats ,-..� ---------------------------------------------------- -----(Title)--------- C t?+� ( P 9 system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYE1y 4 _.« ,. REVIEWED BY_-. =sem:%'-:- DATE-_ 1 r ---------------------------------- ---------------- --------- -------- --------------- ------------------------ ---- ------------- - --------------- DATE----------- ------ - BUILDING PERMIT ISSUED------------------------------- ----------------- -- -- --------------------------- -- DATE---- ----•- - - Alterations and/or recommendations:___-- __.............. r r = f -------------- - - .:...� --------- --- ----- ----------'.............- - :^-r. ----------- --' } r ----------- -------------- -------------- -------- r. ------ --- 1 FINAL INSPECTION BY:.---- ----.-dt - ------------- -------- ------------ Date.....---- ------------ ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CB 9 REVir ED B-59 3M 3-'63 F.P.Cd.