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FOR OFFICE rJSE: --------------------------------------------------------- APPLICATION FOR SANITATION- PERMIT Permit No. _.1 ------------------------------------------------ (Complete in Duplicate) ,, . This Permit Expires i Year From bate Issued "Date Issued Application is'hereby made to the SanJoaquin Local Health District for a permit to construct and'instal the work herein This application is made in compliance with County Ordinance No. 549, 81J^ t e L JOB ADDRESS AND LOCATION_._ ---. ------ L r -.d Owner's Nam -za ro - ------- - a_r ,4Z dL..... Phone---. -------------------- ----•-----:--------- •_ �_'?� ra Ela_ Address---'�----&�------�a.}-.�!�r----A-=�--•--f-��.xz ��w ---•---•-----------------•- Contractor's Name . �:,.. r-- �.._ f-------- -------------- Phone.- -- 6 - ------------- ---- ti Installation will serve: Residence JE- (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Water Supply: 4lg units:;--/-__-Number of bedrooms _3---- Number of baths _Z__ Lot size __.-�_x___ _-- 'Z_____ Public system:[Ej" Community system El Private E3 Depth Depth toWater Table -------- ft. Character of soil to a depth of 3 feet:!,Sand f[T�Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------.--_-------) No E�-- New Construction: Yes ❑- No ❑ FHA/VA: Yes ❑ No E- 1TYPE{OF INSTALLATION AND SPEC IFICATIOfVSc' 4 I" 4L f; F �J (No septic tank,or cesspool permitted iic se f publwer:is available w1+hin'200"feet.).' _ Septic Tank: Distance from nearest well" r;++ `Distance from fa`unda$ion_ "b:__'�"Matera` e > od -" [ ` No. of compartment �. ___size__�_� _ __ --?-" Liquid de tE�___--"`x�---___._ oc9� ti f q p. Capacity - l tbisposal Field: Distance from nearest well__A/!??_._.Distance from'founclation_1A----------Distance to nearest lot line.--If [g- Number of lines-----�.--�-------------------Length of each line-- 0-U--'�-- �r_------Width of trench- - ----•------- --------- f + Type,of filter.material--- '_ . - <___,__.Depth of„flter..mate rial___i 8_'f______--Total length_________L_r-O__.r_____-r- Seepage Pit: Distance to nearest well_____________________Distance from foundation___________._-_.__.Distance to nearest lot line---------___.._ —[ -- rnbe-�oF-pits- ---Lining material-----------------#-----Size: Diameter----:--------:_,_r��epth--.-------------------�- Cess Cesspool: D;stance from nearest well --• g p _.._- istanc-e from foundation.----.--�--------- Linin material------------------------------------- ---------- -------------- ---- ---------, ❑ Size: Diameter - -p:—:�erfih = �'��; - =---- Liquid Capacity _.w ' gals. ' Privy: Distance_frem earl estwell---------------------------------•-----------[--Distance froom"ar5-sfi--bun ----------------- ----•------ --------- --- x El fJlstante to nearest lot line__'___________________ - Remodeling and/or repairing (describe)_____________F _ "^'`"-T- <___----_.__ j I T "�-•- f -----------•--------------•---- L i € ' ---------- ----------------------------- ----------------------------------------------------------------•--------•--------• ----•------------------------------•-----------__---------_._:„ t ; ------------------------------ - ----------------•------- ----- -- - ------- -------- --------------------lk------------ -------•-------------------------------•-------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s t arid rules and regulations of theSa J quin Local Health District, f f 1 $r(Signed) ---; -- ' � � ------- -----{Owner and/or Contractor}. - - --- - -- - ------------ (rtle� - - - . ' By:------------•-- -- ------------ ' Plot..plan,-showing-size-of-lot,-location-of,system_in relation;to,Wells, buildings, etc., can be placed on-reverse:.side)A" r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___--__._ ___�. .- _.- -. �[ I --'------------------------ ----- -----------------------------�-- DATE------{--`-l� -�- ----------------- REVIEWEDBY ------------------------- --- ----------------J_ DATE----------------- -------- BUILDING PERMIT ISSUED---- . ---------- ------ DATE I t t ----------------------- Altecations and/or recommendations:__.___..__ .EI�/y-:-- --- . ----_"--- , 0 "" --------------------------------------- - ---------------------------------- - ------ ------------------------------ ----- ------------ ----•---" -------- �?. s0[1i _F -- --------------------------------------- --------------------- ------------•-------------------- ------- -- --------------------------------------------- ---•- ------------------•---------------- L.LQ UPI ------- -- -----------• --- -•-- -•------------ -- ------- ------ - ---------------------------- ----------------- ----- olfet--------p�A�R.M&q!�• , -------------------------------- --- 5 � FINAL INSPECT! BY: - - - - - Date----- "► . �. . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 P.Haselton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9rh Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 3M 3-'63 F.P.CD.