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FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMI Permit No. ._ _--__- -- - (Complete in Duplicate) pd9__ .._ __�-- - __._.. This Permit Expires 1 Year From Date Issued N 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-------Zell?------------`t� .-----... ----------- ' %P�,r�TD.+.� PhoneA Owner's Name----------,4��..........le.,=........ -f -- Address-----•- ------------•---------- -----------------------------------------------------------------------•-----------------------•--------•-----•-•-----•-----------•-••-•----••----- Contractor's Name------ all----�...�f(� ��. . . Phone_........_s .d......Q_. _... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/--- Number of bedrooms _:2! Number of baths --- .. Lot size ._-/00-_ /10.0................. Water Supply: Public system 9 Community system ❑ Private ❑ Depth To Water Table -------- ft. Character of soil to a depth of/3 feet: Sand E] Gravel [1Sandy Loam[IClay Loam jo Clay ❑ Adobe,g Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 5j' New Construction: Yes ❑ No Q FHA/VA: Yes ❑ No ❑ 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 Disposal Field: Distance from nearest welIN-QN .-Distance from foundation......1_Q_.......Distance to nearest lot line---- ---------- a.�cJl Number of lines___._____.._ Length of each line.--_-----s� -` _. --•---•-Width of trench.- --_--_•..,�',�_--•--•••. (� ..- -----_----__--_ Type of filter material-_.- �X-.._-Depth of filter material--------1,45'_".__Total length...............y .............. Seepage Pit: Distance to nearest well-__ 11W_6_Distance from foundation__.-./___...__.Distance to nearest lot line..._.S_.___...- \ ® D Number of pits--------I-----------Lining material__��------Size: Diameter--------::;J--y-----Depth----------- Cesspool: Distance from nearest well-----------------Distance from LiquidCapacity...l ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------- q ------••---••--._..-•...gals. Privy: Distance from nearest well----------.------------------------------ --.----Distance from nearest building--------------------------•__.._-----__--. ❑ ------------•---------- Distanceto nearest lot line-------------------------------------------------------------------------•----•---•-•--------•---•--•-----•-------•---- Remodeling and/or repairing (describe):__.._ / � 7 � ----------- -------------•--------------------------------- ---------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- -- ---------------------•-------------- -------_----------------------------------------------------------------------------------------------------------------------------------------- ---- --- --------- - - - 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)------------ =-19--- ------- /'7� --�#-- SOA), -------� ---------------------------- ( nor and/or Contractor) ----------------- --------------------------------- (Title) ----- �� By: -----• - le) (Plot plan, showing size of lot, location o ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ____ 'C- -------------------------- DATE__._-. -.fit._-(€3------------------------- REVIEWED BY----- -------------------------- --------------------------------------------- DATE......----------------------------------------------------- ------- ---------------------------------------- ---------- ------ DATE------------------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- ----;:--- - --- -- p'4 Alterations and/or recommendations:._'. -- _.- -' ------------h Ly!'�- •�.1 & _.L -------------------------------------------------------------- •___•____...__...____..._..__....._...__...._-_..__..._.... -------D_J�,,-----------------------(.- ------ -------------- --------- --- --------------------- Date---- ° J-•- ------ ---------- ---------•---- FINAL INSPECTION BY:.-�: ._...- . ._ - • SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS