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0 Lake 54-p APPLICATION FOR SANITATION PERMIT Permit No. ,_.//._. :. ..Z-- (Complete in Duplicate) q/ Date issued ,__.1.�4,_.�__ 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. a3vo JOB ADDRESS AND LOCATION.2 11: QLU n. ----- -------- . !_-__ -= ...... -- --1-- -.----•,- - Owner's Name -------- -••- Ct _ ----------•- _ hone_------ Address .. Address----------- 47710-21--- - �- s -------- Contractor's NameS►Cu-. -'�lJ-11 .�s F ..............•------------------------------ Phone ,.- -Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ z r Number of living units: ___. __ Number of bedrooms __/__ Number of baths /.... Lot size ........ ____ _ _ --------._.__ Water Supply: Public system ❑ Community systemrivate ❑ Depth to Water Table ,.__:,_. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No 2-__N__ew Construction: Yes Jul iso L7 FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wella-QQ. Distance from fou dation_10_f____•_.__.Materiafl No. of compartments_!___-_ ___. ----Size_•__X ____ ___Liquid depth----X-47-_� __ Capacity......A _ q Disposal Field: Distance from nearest welLl_Q_Q_�.__Dist'ce 3 foundation___ _Q_f.. _Pistance to nearest lot line........ ` Number of lin ____Length of each lin Width of trench _��Ze---------------- ---------------- Type ____ ____ Type of filter matenaly_�_ ________Depth of filter material__1_$�� Total length.....9 _ Seepage Pit: Distance to nearest well ----------------Distance from foundation....................Dittance to nearest lot line ❑ Number of pits_________________ ___Lining material-----------------------Size: Diameter_____ ;____ ____-____Dept h_-------_----------.------------- Cesspool: .____-___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 -- •--- --- Remodeling and/or repairing (describe) ------------ --------------------------------------- --- •------------••--••--•---•---- `� -- -------------------------------------------------------------------------------•---- --•••--• ---- ---------------- -•_------------------------------------------------------ ---......................-------- ----- ............................................................... -------- - ---------------------------- ---------------- ---------------------------------- ....... A, � -- 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 regula-ti2ps of the Sa Joaquin Local Health District. d � ` (Signed)7 Djav-:4-A t4 ------ --------- --------- Contractor) By:----------------------------------------------------------------------------------------- (Title)------------_-------------• ---- ----------------- (Plot plan, showing size of lot, location of system in relation to well uildin s, etc. an be placed on reverse side). FOR DEPARTMENT USE C NLY APPLICATION ACCEPTED BY ---{_` Q-_-------------------------•-••----- --------------------- DATE ----_ q-1-3/4-7------------••-•----- REVIEWED BY----------------------------------------------- :5 3..----------------------------------- ---- ---- DATE - --f•-------- ---------------------------------------- BUILDING ------•----•----._--- BUILDING PERMIT ISSUED......................... _-------------------------------------- DATE-- - ---------•---- --------------- Alterationsand/or recommendations-------------------------------------------•---------------------- -----------•------•---•----•••---•---..........................................--------•- ----- __ . d t - `.Y f`-FINAL INSPECTION BY:'-7--- , -- __ Date------------------------- SAN ---- ---•--•---•----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C"Street Stockton, California Lodi, California Mar face, California Tracy, California ES-9-2M Revised 1.57 F.P.Co.