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FOR OFFICE USE: ------ ---------------- ---------------------- APPLICATION FOR SANITATION PERMIT Permit No. .f.___�._._-.%. (Complete in Duplicate) Date Issued'_ZdA�___6� _.----__--------,_------- ----- - ------------------ This Permit Expires I Year From Date Issued - - D� r�- l{ o -2z Application _ -- ion 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. 544. L E O ADDRESS AND LOCATION_ _A!_D E/ L.A�JV.S � Y J�b�z -©'--- r----- k _ Phone T�2-j �--- Owner's Name------hx�-'----�}�-�-..�--�-�------------------ ----------------------- ---------- - -- --- --------------------- Address----------_----�4_q-J-------- �� Y L{ '•• 1�•�,-------•- ------ -----------------------_--_`-/-------------------------- �_�_P_ Contractor's Name----------- Ii ,t ----ZZ/ ------ ------------= Installation will serve: Residence `/ Apartment House ❑ Commercial E] Trailer Court E] Motel E] Other ❑ t t Number of living units: __1---. Number of bedrooms Number of baths _-1__-- Lot,size ---------------------- Water Supply: Public system ❑ Community system ❑�PrivateE2' Depth to Water Table _YCS ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam" Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date__________----------) NoZ" New Construction: Yes ❑ No Dr FHA/VA: Yes ElNo -,.._.. TYPE OFINSTALLATION AND SP—ECIFICATIONS: (No septic tank.or cesspool-.permitted.if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well____ ____________Distance from foundation---------------------Material__._-___.--.----_____-: _______....___--...- [] No. of compartments-------!------ ------------Size---------------------E----------Liquid depth-------------------------Capacity------ --------- ----- Disposal Field: Distance from nearest well_ '__._.Distance from foundation____-- _---.Distance to`nearest lot ' �� Number of lines,--.------ _ _.____Length of each line------- 5---------------Width of trench.____._-=_ ____.--.---_______ Type o£„.filter..materiaL_ c_ _G' Depth of filter material____.__ ��-.,-Total length---------------.__..?___ _.�___.- Seepage Pit: Distance to nearest well -__J.b_t2_'. ._._Distance from foundation------1D_-'-.__Distance to nearest lot line-_-s --_ C I ------ C(�4 Number of pits....__I---------------Lining material____ `-�C�Size: Diameter-_:-��-- -..__-Depth_-..---__.___?--�__.___ Cesspool: Distance from nearest well_________________Distance from foundation--------------- Lining material-----------._..____---____.__----._. ❑ Size: Diameter----------------- --------------------Depth-- Liquid Capacity--------- -------gals. O Privy: Distance from nearest well_______________ ----------------- --------------Distance from nearest building----------------._._________-.-----___---. 9 ❑ Distance to nearest lot line--------------- -------------- ---------------------------------------- ------------------------------------------- -------------------------- t -- -----—�s�-� ✓G-------mss =-'"' •----• - Remodeling and/or repairing (describe]:._____��_��__-1-`-�--- - -------------- e -------------------------------------------- ------------------------------ ____________________________________________________________________________________________9___-_-______-______-..__________-_---.-_-_._-.-_.__..-___-.--____-_-_._--____.--.-__.________--______._-_---_ q 7-----------------------_. --_.._ ------------------------------------_____________________.____-__-----------__..____-_--_-_-_________---_______.________--__-_-____.-----________-_---______-_----_--..______--_L - 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) c, � e nor and/or ar) --- - -- - - --'r --k �i ------------- (Plot plan, showing size of lot, loca on of.system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t DATE-.1-8."/ -`` APPLICATION ACCEPTED BY--- •---- . �---- --------------- --------------------------------------- --- ---------------------------- REVIEWEDBY----------------------------------------------------------------- ----------------------------------------------------•--• DATE-------------------------------------------------------- --- BUILDING PERMIT ISSUED----------------------------- 4 DATE--------------------------------------------------------------- Alterations ---------- -Alterations and/or recommendations------------------------------------------1--2------------------•------------- --------------------------------------------- ------------------------------ F I ------------•----------------- ------------------------- ------------------------------------------------------------------------------------•--------------------------------- -------------- i i 1 ---------------------------------------------------- ---------•--------------- -------------=------------- --------------------------------------------------------- ------------------------------ ---(--------- -------------------------- ----------- ------------------------------------- -------------------------------------- F]NAL INSPECTION BY:-f:v�.- ---- • -------------- Date_.f&- -�---6-------- - ----------------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haiettan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracyr California ES 9 REVISED 9-59 3M 3-'63 F.P.CC.