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FOR OFFI Ute: ------ -------"_ ____ ---- ---- ---- ------ - ----------------- -------------------------- __--------.-- APPLICATION FOR SANITATION PERMIT Permit No. .. -ted__ ---------------------- -- ------------------------------ (Complete in Duplicate) 7 � ,.., _ Date Issued _____��_�} _- ----------------------------------------------w.__..._.. This Permit Expires I Year From 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. 4 JOB ADDRESS LOCATION..__ // Lac ti Owner's Name----- --------------------------------------------------------------- ----- Phon° Address- -----------------------` crZ.`.l -------- ---------- 7— .v. --------- G Contractor's Name...... c.�i�S t�.�s _. ru .: Phone e Installation will serve: `Residence Apartment House ❑ Commercial ❑ Trailer Court El Motel F] Other E]i Number of living units: --- --- Number of bedrooms __ Number of baths Lot size ...,../.. >, ------ -------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _,`ice ft. Character of soil to a depth of 3 feet: Sand ❑ f Gravel ❑ Sandy hoam ❑ l4Clay 'Loam ❑ Clay E] Adob Hardpan F]s - / I Previous Application Made:- (If yes,date------:..:.'._...-_) No f New Construction: Yes' [] No ❑ FHA/VA: Yes ❑ No E] TYPE -OF INSTALLATION AND SPECIFICATIONS: ,(No septic tank or.cesspool permitted if public sewer is available within 200 feet.) gpti eTp k: Distance from nearest well................yDistance from foundation_..._.-_-_-...._-..Material.......-__•..-....-------.._...------...._.---- ,�/JiJ No. of compartments--------------------------iSize_`_-_--------------- I-----__-Liquid dpp? h---------------------------Capacity--•----------------f- Dis os I Field: Distance from nearest well-..�AA/�'_.Distance from fcundationAl.............Distance to nearest lot lines j.�__.. t Number of lines....__--1. ..____..)Length of each line._!/(_-------_ 7-------Width of trench._-., -_$�.................. of filter material._.. . '__-.',Depth of filter material-----, ...-.. _Total length------- ---_.------------------ Type .. � SeW ---- e Pit: Distance to nearest well__/ I -�---- ._Distance f,Lom foundation.__ Q_,...-._.Distance to nearest lot line..-+�r....._... Number of pits.-... /-------------Lining material._... --............. <� 1 Cesspool: Distance from nearest well................ Distance from}`foundation -- ... - material_......__------------..--- Size: Diameter--------------------`----- --------De th--------------=--------- •-i -- -- - Li Liquid Capacity ---------------gals. O. Privy: Distance from nearest well---------------------------------- -----..Distance from nearest building..............._....-.....__.- ---------- ❑ Distance to nearest lot line----.----- - ---------------- 4 Remodeling and/or repairing (describe): 1' ----- � ------- ----------- �a------- 9 - ----•-- •----------------- - -- -------- - - 1 A -------- ---------- --------------------------_------------------------------------------------------ -------------------..-----.---------------------------- 1 hereby certify that I have prepared this.application and that the work will be done in accordance with San Joaquin County ordinances, S+a+ ws, and regulati4s of-the San Joa uin-Local Health District.k _ wrier and/or Contractor) (Signed)--- -- ---- r- BY: ------- ••--•--•----------•---- ---_--`------ (Title) (Plot plan, showing size of lot, location of sys in relation to wells, building c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..W- - - ------ - - '----------------------------- DATE----------�� . �~----�[=--/------------------- REVIEWEDBY---------------------------------------------- - ----------------------- -------------------•---•-------------------- DATE-------------------- --------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------- ---------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:----------------------------------=-- -------- -----------•--•---------------------------------------------'•----------------------------..----••------------ -•-------------------------------------------------- --------------- ---------- ' -------- ------------------------------- ---------------------------- -------•----•--- ------------------------------------------•---•-----------------------------------------------•------------------------------------------------•--••- ----------------------------------------------------- FINAL INSPECTION BY:. =' Date------------`•� -- 1 •1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street L5W,,,sl 9th StreetStockton,California Lodi,California Manteca,California California `+� ES-9 REVISED 9.59 Fr P•CO.2M6-60 A T ! -mss