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UFHCE USE- ....................... SE: r -� .. - La.n7 ,0 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) /�I -------------- This Permit Expires 1 Year From Date Issued Date Issued ----- ----.....7A 3 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----------23_Q-Z-•--------- --------. _lea ---------------- Owner's Name------- � �_ Address ~ ��---------- 12A-� i?• N >! f:.�+.)...._. Contractor's Name-------P.'!° Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._.__._ Number of bedrooms __�k._ Number of baths J_ir Lot size ----3------lq_C_etLE-------------------------------- Water Supply: Public system ❑ Community system ❑ Private Cff Depth to Water Table yQ_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel p Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: {If yes,date____________________ No E' New Construction: Yes V No ❑ FHA/VA: Yes ❑ No KI TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well400_......!Distance from foundation---1 e ______Mater jl ----------- F"T -_---___-__--. No. of compartments--- --------------Size----',�7.aG,S�`_c__AV-----Liquid depth--------/-=a---------Capacity--- ) Disposal Fie#d: Distance from nearest well. -+--I Distance from foundation-----AO---------Distance to nearest lot line------SI.___-_--__ vP Number of lines---------------7----------------.Length of each line--------7S---________._.Width of trench--------,?--- rj Type of filter material------/ltAr-!<-----Depth of filter material------lN___......Total length------------------------ tj Seepage Pit: Distance to nearest well---1.44C -------Distance from foundation____'=v1.___- Distance to nearest lot line----�--.___.._ � .__.__Linin material_.__/ YAK---Size: Diameter_.___-� _}�..-_--Depth----....�:_ -------------- Cesspool: Number of pits-.-.-__-�,. g - -------------- � Cesspool: Distance from nearest well-----------------Distance from foundation------------ -------Lining material-- C ❑ Size: Diameter-------------------------------------Depth_----- ---------------------------------------------Liquid Capacity----------------------------gals, j[ Privy: Distance from nearest well----_--------------------------------------------Distance from nearest building.__._____________-___________._-__--__. ❑ Distance to nearest lot line_____________________________________________________________ Remodeling and/or repairing (describe):--------- rlNSi_-�4�-------- ------------- Fir------------------- -------------------•----------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- ---------------- -----------------------------------------------------------•---------------------------------------------•------------------------------------------------------------`----------------------------- ------------------------------------------------------------------------------------ - 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 rre_gullations of the San Joaquin Local Health District. (Signed)---------F c{r'� -------tom'"-- `--' - ------------------------------------------------- _________________.. caner and/or Contract .: BY: `-Oil LC-s.c. t�"� -- -----------------------------------------------(Ti+le) or (Plot plan, showing size of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - ----------------- --------------------------------------- DATE----- q ' - REVIEWEDBY----------------------------------------- -------------- --------------------- -------------------------- -------------------- DATE------- BUILDING PERMIT ISSUED----------------------------------------------------------- DATE--------------------------------- t and/or recommendations: �1 �0�� 5 ` 171 "ec. .......... ---------S ------ C %_ -------------------------------------------------- - ---------- --- ---------------•----------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- FINAL INSPECTION BY.-.,,----- —--------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-S9 3M 3-'63 F.F.Cl2.