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F�R OFFICE.U5E: I -_-1 ------------------------/::3-0--- APPLICATION FOR SANITATION PERMIT Permit No. _-1.1112----- ------ ------- (Complete in Duplicate) d 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. : r JOB ADDRESS AND LOCATION- ---- ------- � `-5 �f' • ------....4A' -------- 457V '� )A) cf Owner's Name.---'KL 11/e----.. ------------ ,L_4! _/I/1L1A5CF,441fd_k0_" Address-------------------------r � 7 ------------------------------------------------ Contractor's Name cl-1 �1,s.� ry ----------- ---•-----. Phone ---•----------------••- Installation will serve: .Residence 10 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. _:C_:___ 'Number of bedrooms 5... Number of baths _y_ Lot size ___ ------------------------------ Water' Supply: Public Esystem ❑ .Community system ❑ Private Depth.to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoaYn ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: (If yes,date....d______--------) No New Construction: Yes E] Na FMA/VA: Yes E] Nofc?i 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_____________' _ -- ---------------- ------------------------------- El 4zjll�* No. of com artments____________________ ___Size_______-_______-__._________.__-Liquid de th__-_________.___________.Capacity Disposal Field: Distance from nearest well_._ Q_-'.__ °.Distante from foundation____- ---______Distance to nearest lot line___ .......... ] tLA Number of lines_____________J_______ __:_ ___,_Length of each line__ ___.__ r2_'______.. Width of trench______,`- '�___._________ Type of filter material__�_•- �_.Depth of filter material__-----1� :_._._Total length-----------------s3C�_______________ Seepage Pit: Distance tonearest well'---!_60_'_______-Distance from foundation.__t3.�.'..___.Distance to nearest lot line___J�-_______ P 9_ '" �r_"_.._Depth--- --- - --------------- 0 Number of., its""*_1'""" 'Liriin 'Mate Size: Diameter._____ t � Cesspool: Distance from ne}arest well---.-.------- Digtance'f from foundation Lining material_______________________________ _. ... ❑ Size: Diameter--=t ...z.'.. ........I....._. . Depth--------------------- i:.------------------------Liquid Capacity- --------------------------gals. M --_ Privy: Distance from nearest well____'.__.__________—____- _______--____--_4D,istance from nearest building----------__------.----------------------- D ❑ r - ; Distance to_nearest lot line----=--- ----------------------------------------------------------------------------------------------------------- ----------•--------•---- V ' Remodeling and/or re pairing (describe)----- .-------V5--115 T -..-?-----------------------------------t-----------------------------•-------------------------------•----- - -- ----------------------------------------------- -- _ — - ----------------------------------- ------------------------� --- ---------------------------------- - ------------------------------------------------ -----------------------------------------....---------------------------------------------------------------------------------------------------------------------------- ------ A I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County p ordinances. State-laws, and rules-and-regulations of the San Joaquin Local,Health District. (Signed)--------------Pe / /cs/ � ��-' _ [Owner and/or Contractor) i9 ste 1 fv== _- ------�` Titles (Plot plan, showing size of lot, location of system_in relation to weIIS,.:buildings, etc., can be placed ontreverse side). ; . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - ------------ --------- Y = ---------------•---- DATE------1f1 ---- ----------------- - ------------------------------------- -------------------------------------------------------- REVIEWED BY ---------- DATE --BUILDING PERMIT ISSUED ----- -`- --_ ---- DATE.._.------- }= � ----------• ---- - --- Alterations and/or recommen�datons:___ - --- --- ---------------------------------------------------------------------------------- -----------------------------------------------------------------,•--------------------------------------------------------- ---------- d N ---------------- -------------------------------- ---------•------•----------------- ---- - 4 _ Y 4 ,i� FINAL INSPECTION $Y:--- /�� £� -------------------- ---- .�'/`. .- .: Date---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 9-59 31A 3-'63 F.P.CD.