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FOR OFFICE USE: ------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------- ----------------- --------- (Complete-in Duplicate) /( f -- --- This Permit Expires 1 Year From Date Issued Date Issued ------ Application _--_/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---I- 7 _ -----So_ ._. -� �' ------ ----------eA Owner's Name---- G - L ------------:7?------------- ------ --- - ----------------------------------------- Phone-----,/— r Z Address .o'. Q._.. `` -------W.'ie '-.�`---------�/+II--Misr ------.�Fv--------------' 'C,t -. Contractor's Name---- ' - hE ------------------- --------------------------------- -------- Phone------$ �s ... Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _,fC_-_ Number of bedrooms _ --- Number of baths_Z_ Lot size ----/_ "e_____________________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table-_ — _ ft Character of soil to a depth of 3rfeet• Sand)( Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dat eF....- _F,},, } No� New Construction: YesX No E] FHA/VA: Yes E] NoX TYPE OF INSTALLATION AND SPECIFICATIONS:• . `' ` IL ,(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welL_� ._ Distance f om ound lion _! - Material _._e_C/1/Ci !-e-j`– -----. p `l! No. of compartments._.-_-- _ _ ___Size__�_../,�?_ Liquid de th____-- ro Ca acit / a- f q R P Y Disposal Field: Distance from nearest we€i- ro-----.-Distance from foundation__./64--------Distance to nearest lot lin + v Number of lines ----- -------------------------Length of each line-- -- - -- ---Width of trench-------A;L... . Type of filter mate rial -e_/__Depth of filter material---- __.---------Total length____ ______________ Seepage Pit: Distance to nearest well----------------------Distance from foundation___-_____._____.___.Distance to nearest lot line--,--.----------- 1 ❑ .............. Size: Diameter.---------------- Depth_.--_-----.-------- Number of pits--- -----€-----------Lining` material-----•.. ----------_--- Cesspool: Distance from nearest well ____...____.__Distance from foundation................. ..Lining material___.-.._____..._____._.__ ❑ Size: Diameter- -- -----s-------- ---- -----------Depth----------- - -- --------- - - - -------- -------Liquid Capacity----------------------------gals. Privy: Distance from nearest well.............................._.._...-.____._.._Distance from nearest building___f-_ ______.____.__. ❑ Distance to nearest lot•line .:------------------- -- .. - ---------------------- Remodeling and/or repairing (describe):-------------------------------- ----------------------------------------••-•----------------- -------- ----------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- -- --- ---------------------------------------- ----•------------- --------------------------------------------------------------------------------------- -------------------------------------------------------------- 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 Sa Joaquin Local Health District. (Signed)___ -_------ -- --------------(Owner and/or Contractor) -- BY---------------------------------- ------------------- --- ----------------------------------------(Title)----- --- ------ ------- -----------...._.. .. - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED --------------------- -------------- DATE-- ,// - - - REVIEWEDBY---------------------------- -- ------ --- - - --- ----- -- ----- ----------------------- ---------- DATE---•----------- -------------------------------------------- BUILDING PERMIT ISSUED------- -- ----------- ---------------------------------••--------------------------------------- DATE----- ------------------- Alterations -----------------Alterations and/or recommendations------------------ ---------- ---------------------- -------------------------------------------•- ---- -------------------------------------------------------- ----------------------------------------------------------------------- ---- --- ----------------- - - ---- ------------------------------------ -------------------•----------- -------------------•----------------------- ------------------------------------------------------• ------------------------------------ --------------------------- ---------------------------- ----.............................. --- - ------------------- .� ----------•------------------------------ -------------------------- .... -------- ------ - - ------ ---------------- --------------------------------------------- ---------------- I-------- ------------------- FINAL INSPECTION BY:.. ` ----- �1 L ._ Date----- - /72!��.. 768 �" SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press t.