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FOR OFFICE USE: I � ---- --------------------- APPLICATION FOR SANITATION PERMIT Permit No. -----IEZ -- (Complete in Duplicate), Date issued _------------ --- This Permit Expires 1 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. JOB ADDRESS AND LOCATION____-_-: -- ----- � ' Owner's Name----------------��d--&4------------ ` f T -------------- -- ------------------- ------ Phone. •. a Address------------------------ -A-------R= 1------- ------ ----------------------------------------------------------•------------------------------------ Contractor's Name-_ r^{ /�. -/S ll=-•------------------------------------- ------ ----- ---- Phone-- A-•rte �� I Installation will serve: Residence % Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--- Number of bedrooms —1- Number of baths J---- Lot size -----------_9 -- �� --------- Water Supply: Public system ❑ Community system ❑ Private, Depth to Water Table _ ft, Characterof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam�M Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: lif yes,date.-------- -----J No;Z New Construction: Yes ❑ No )K FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fink or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________________Distance from foundation--------------------Material_____-._____._.__.._______________.- -_.._. 0 £Xl�i/A�k3 No. of compartments----. -------------------- iZe--------------------------------Liquid depth---- ---------------------Capacity--•---------------/---- � Disposal Field: Distance from nearest well_--e_"4P4P_/Distance from foundation----ems__ -----Distance to nearest lot line------�!__.____. 4 ® kx/•S3.4-G-Number of lines___.______..._.__ --___Length of each line______ _._ __ _ Width of trench------- -'___________________ --— ----- ?9d Type of filter material----- 1�_-Depth of filter material---_ _ --------Total length-------- =------------------------ f � f Seepage Pit: Distance to nearest welL_1� -----___Distance fr m foundation__-�Q __--_.Distance to nearest lot line---- Number of pits-__--___�-- Lining �material___g11eC'C�Size: Diameter__- _X.__----_Depth_ -> - --------------- Cesspool: Distance from nearest well________________Distance from found ation........... .___.___.Lining material------------------------------------- ❑ Size: Diameter------------ -------------- ----------Depth------=---------------------- --------------------Liquid Capacity-- ------------------------gals. Privy: Distance from nearest well--------------------------_-------------`_ __Distance from nearest building_----------- ---------------- ❑ Distance to nearest lot line--------------- - ----------------------------------- ---•--------- ---------- ----------------------------------------------------- - Remodeling and/or repairing [describe]:---/Y -:-7—E'---4--- i'f_5}' C` --k..__ - '1'. ------------------------------- --------------------------•-------------------------------- ---------------------�------------------------- --------------------------------•---- ----------------------------------------------.---------------------- ------------------------------•-•------- ----------------------------- ---•------ ------------------•----------------- --------•------------------------------------------------ ------}------- ------------------------------- 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. 5ined ---------------------------- ------------------------- (Own and/or Contractor] g )------------- l - , BY- E'- -- - ------._Title------ 51 (Plot plan, showing size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----0-- Q'S -------------------------------------------------------------- DATE----11 � ---------------------------- REVIEWEDBY-------------------------------- -------------------- ----------------------------------------------------------------- --- DATE.----- --------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------—---------- -------- ---------------- DATE ; s Alterations and/or.recommendations:__il_ ._►T--'--'P- -_---- ----------t►115+ a_h---------------M ----�'+ � s------- ---------- ------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:---- ..,. ¢ --------------------- ------------- Date--------1-1. � '(PA--------- ------------------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-S9 3M 3-'63 F.P.CD.