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R � APPLICATION FOR SANITATION PERMIT Permit No. . � (Complete in Duplicate) �(g.Date Issued -'--- ----- ------U ` 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_______________128 West_-__.Hazelton --St. ---------------------------------------------------------------------------- Owner`s Name Lavada Kelp HO. -8159 -- Phone ---------- Address------------------V28---W+ Haien.ton -----------------------------------------------------------------•------------ -- --••-•-------------------------------••----- Tnc. .- Phone-----Hq' Contractors Name-- D$Za '� P1+ C Tst3k sErV. �_ Installation will serve: Residence [X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:1-.___ Number of bedrooms _-2_._ Number of baths __.1.. Lot size ------X--12____------------- Water Supply: Public system [? Community system ❑ Private ❑ Depth to Water Table -_35_ ft. Character of soil to a depth of 3 feet: Sand F] Gravel ❑ Sandy Loam E] Clay Loam [IClay E] Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No a FHA/VA: Yes ❑ Not 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----------------- from foundation--------------------Material---------------------------------------.---____. E;3sting No. of compartments--------------------------Size-------------------------------.Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well------------------Distance from foundation___--_...____--.-._.Distance to nearest lot line-_______----_._.. E�eting Number of lines_____________________ i --------------Length of each line-----------------------------Width of trench----------------------------------- � l Type of filter material-------------------------Depth of filter material ---.------------------Total length______-_---_____-__-.____-______----.----- p n0 ion--5Q Distance to nearest lot line------- F__.__ 7" k Seepage Pit: Distance to nearest well------------ from founda#ion__ __________ ____. -Linin material__9PX_. --..Size: Diameter--- �� 2 > IDs%.-----_-- It Number of pits`----------1---- - g - --- Depth.._.-,� ----------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------ 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):------add, ,ng--- 1 -ex'_r~ d.._to__.e3LiB iIlg---8y_Bt_Em------------------------------------------ -------- N --------------------------------•----------------------------------------- [}cu -----------=--------------------------------------------------•--------------------------------- 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. , DG &_. LjJtC_- '8Y11L@I'V. TnC-•---------------------------------------------------------------------(Owner and/or Contractor] (Signed)---------- i By:--•-_Perm Q* W_ rthan--------------------------------------------------------------------------------(Title)-----G en.---xgr------------ --- ------------------ (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 BY---------- - ---------------------------------------------------- DATE------------------ i _w - - r=---------- REVIEWED --- ----REVIEWED BY------------------------- - DATE------------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------—-------------------------------------- DATE------------------------------------------------------------- Alteration and/pr recomm ndati�- '` ------- ------ - --- -------------------------- --------------- -------- ; - --- - - ------P--�-- --- -�_--z� ------ ----- FINAL INSPECTION BY:. --------- Date---- ------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street W Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California i E5.9-2M Revised 8-'59 FTP Co. i