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APPLICATION FOR SANITATION PERMIT Permit No. _5733. _ -- (Complete in Duplicate) Data Issued ,cation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. application is made in compliance with County Ordinance No. 549. ADDRESS AND LOCATION--------- �- - -------LA✓_.it---------lzz;_5�Q_�t� ------------------------------------ rte--- Uwner's Name------------------ _ 1V---------------/F� �� !Z_ la~------------- --------------._. Phone - ,, ----------------------- Contractor's Name �`/��/��t"?icS.t ^5� r' x------------------ I-�o7�e_,4 ��_4�_ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ___ Number of bedrooms _Number of baths _./_._ Lot size ------- �_- --- _. J_•___-__ Water Supply: Public system,P" Community system [] Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel (] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E ' Hardpan ❑ Previous Application Made: Yes ❑ No XJ New Construction: Yes ❑ No A, FHA/VA: Yes ❑ NoA TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep T k: Distance from nearest well________________Distance from foundation__.____---_________.Material_______.-______---.-- No. of compartments--------------------------Size------•-------------------------Liquid de th Ca aci p ty--------------------- Dis " eld: Distance from nearest well.../ �ll Distance from foundation_____ .......Dist ce to nearest lot line_____ v Number of lines____________ __ _ _______ ____Length of each line-----e!!r ___ Width of french._____- Type of filter material------ . o�1C--Depth of filter material__...._�,�__.____Toal lengt ___�----._. _ ----------------- Seepage Pit: Distance to nearest welf_____,,�& -Distance fr m foundation___ Distancge to nearest lot line__f i Number of pits - p __________Lining matercaL__---- L'C,�_Size:- iameter____�„�._______.Depth____ ' Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining 01- ----------------------------------- ❑ Size: Diameter ------------------Depth----------------------------------------------------Liquid Capacity-__.....-----------------gals, Privy: Distance from nearest well--- ----------------------------------------------Distance from nearest building------------------------------------------ Distance ___..____.-_--_______ -------.Distance to nearest lot fine ------------- ------------- Remodefing 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 San Joaquin Local Health District. (Signed)-------•----------------------•----------------------------------------------- ---------------(Owner and/or Contractor) - -------------------- By=' --------------------------------------------------------------------- --- Tale - - ---------------------------------------------- ----------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efe., can be placed on reverse side). �4 FOR DEPARTMENT USE ONLY-'� APPLICATION ACCEPTED BY-------•---- - ---- --- -- ------------------- - DATE------------------ --- -- --•------------------- REVIEWED BY--------------------------------- ------- - --- -- ----------------------------------------- DATI= � ------- ---------------------------- BUILDING PERMIT ISSUED----------------- -------�--- -- ------------------------------------------ DATE -� - - - - Altera 'ons a d/ r ec m ndations:---___ ----- ��- --------- -- - ---- - - -- - In -- ---- ---- --- ---- ,: F 9FINAL INSPECTION BY:.----2 ------•---------------- Date--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9,-.-2M Revised 1.57 F.P.CO-