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F R C?FFICE USE: ip- -.--..-.__-_.---.r.------ _._— ------------------ APPLICATION FOR SANITATION PERMIT Permit No. ...1..---.Q-------- G (Complete in Duplicate) Date Issued --------------------------------------------------------- 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 �wiith County Ordinance No. 549. JOB ADDRESS AND LOCATION-------- f .tL7 ------------------------- Owner's Name.--- - -I-I�rA�K_1--•--$ 1 !lr-� ------�!].4 -�_ l- - Phone............ Address---------------------5 iq .Cs-CoeI --2.14-POE.......------------------------------------------_--•------------------------------------- Contractor's Name--------•---- lum-1 511---------•----1AIC------•--------•----------------------------------------•----- -------- ------- Phone. q.&_7-------- Installation will serve: Residence 10 Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - ----- Number of bedrooms An- Number of baths j---- Lot size _k7S_t.___ Water Supply: Public system '4 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 Aff Hardpan ❑ Previous Application Made: Ilf yes,date-----------------_.) No A New Construction: Yes ❑ No P� FHA/VA: Yes ❑ Noy TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: 6 Distance from nearest well-----------------Distance from foundation-------------------Material-------------------------------------------------- ❑ PS'+IK No. of com artments--------------------------Size-------•-------•----------------Liquid de th----------.----._.--- _ Capacity .--- Disposal Field: Distance from nearest well_ ONS.-Distance from foundation------ __._..__.Distance to nearest lot line.._-_�__..... Qfats-V$r' Number of lines---.-----I------------------------Length of each line------- --------.Width of trench-------------.�- _�`.-.-----.- ftfl,D Type of filter material_-ZO.La)G-_----Depth of filter material-----------1S...... otal length----------------------- -S`"! ..--__-_ i Seepage Pit:lrio Distance to nearest wellN__QAJ -___-_Distance from foundation----).P..........Distance to nearest lot line--_4f__f [� Number of�Afl pits.__--.)-------------Lining materiai_1 �_4e_-��_____Size: Diameter-_..____�T. 3 -.-___Depth_._.-_______� -------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material--------.____.______-----_-__----...- ❑ Size: Diameter------------------------------------.Depth------------------------------ ---------------------Liquid Capacity_. Privy: Distance from nearest well-------------------------------------- ------Distance from nearest building________-_------_-_-----___-_-----_.-----. ❑ Distance to nearest lot line------------------------------------------- Remodeling -------------------------------Remodeling and/or repairing (describe):------A),->2---------oe --------4EX/. Zlw --------- pl'S-�E/l� = -------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- s --------•------------------------------------------------------------------------------------------------------------------------------------------••-------•----------------------------------------------------------- - 10 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)--------------- ..... -------------- _ ---------------(Ow r and/or Contractor) .. By:-------------------- �'?x ...�i xC .,----------------------------- --------- Title -- ----` (Plot plan, showing size of lot, location of sydem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ®® 4 APPLICATION ACCEPTED BY...------ - .. s.c.J '----------------- --------------------------------------- DATE------- ` REVIEWEDBY----------------------------------------- ---------------------------------------------------------------------------------- DATE BUILDINGPERMIT ISSUED---------•---------------------------------------------- -------------------------------------- DATE------------------------------------------------------------- Alterations and/or recom end; 'on .._.............. . - ---------------------- ---------- -•---- ------------------------------------------------------ 2 "' *f,-----� --------------------------------------------------------- --- -------- --------- - ---------------------------------------------- --------------•------------- -------•-•---------------------------------------------•-•--------------- ---------------------------------------.---....-------------------------------------------------------------------------------------------------- ---------------- ---------------------------------------------------------------- --------------------------------------------- --------------- -------------------------------------------------- ---------------------- FINAL INSPECTION BY:.-.---. _.�:�_C-tJ----------------------...--------- Date--.....-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-54 3M 3-'63 F.P.CC.