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` FOR OFFICE USE: ,. ..:.--L - ^--_._--._- APPLICATION FOR SANITATION PERMIT Permit No. ........ ...... . r ------------------- --------=----------------- = (Complete,in Duplicate) r - 4--- --- This Permit Ex Expires I'Year From Date Issued-'` Date Issued ---------- "" fP- � 0�-7— 140—�b Application.is hereby made to the San Joaquin Local Heal+h,Distrlc+for a permit to construct and install the work herein described. This a plication is made in compliance? with County Ordinance,No. 549." JOB ADDRESS AND LOCATION------ -:--,3-------_ _ _.__ �} f - --------�--T�-�=�--�----�---------------------=---------- Owner's Name LCA' - - -i_ _LA%_ . ----------------------------------------------------- Phone_L ---------------------------------------- Address-------•--•----------- --- 1 !1 ------------� -Y]�----------------------------- �� — la n7 I Contractor's Name_-.-- Phone-------•-------------------- Installation will serve: Residence Apartment House Q ' Commercial Trailer Court ❑ ❑ Motel ❑ Other ❑ Number of living units: _-I---_:Number of bedrooms ,3--.- Number of baths -3--- Lot size -----J _C "- _ 3- _ -_---•-.---______ Water Supply: Public sstem - 1 _�. _ T pp y� y ❑ Community system ❑ Private P< Depth to Water Table _�O Aft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Cla Loam Clay r ❑ ❑ y ❑ y. y ❑ Adobe ❑ Hardpan ❑ Previous 1%'-Application 1q . ' ,w .., ,r. ... .._ TYPE OF INSTALLATION.AIND SPECIFICATIONS; 1 �No, New Construction: Yes,,❑ No rtFFIA/VA: Yes ❑ No� i (No septic tank#or cesspool permitted.if public sewer is available'within 200 feet.) i f ._ # Septic Tank� Distance from nearest well-__-____--------Distance from foundation-----_-----------MateriaL�•-:�"___--y----__._ ❑ No of partments ---------Size-----•------• -- --------------Liquid depth-------- --------------Capacity--- - - ------- Disposal Fiel Distance from nearest well._LQ�?'----Distance from foundation._..ZT9..`.....Distance to nearest lot line-___� Number_of,lines---•-------•--- -------==-:=i- g---Len th.of each line---------.5_Q==----------Width of trench-- ----' -- -.---- - .Typ-e.of.filter materials.5,--AQ!�-K-----Depth of filter material,---_---__I--X'-----.Total length-------- e-------- = --- Seepage Pit: Distance to nearest welf_..1_QO'_--_-_Distance from foundation_--_ �-�_____.Di tante to nearest lot line----Nd'......� &i Number of pits'-_--_I-------------Lining rriateriah _�_+ � .- _..Size: Diameter--__-__ _ " ...Depth - ' .+'"-x, p ----------------- ❑ stance from nearest well_---__-__P._-_Distance from foundation_`-----------------Lining material_-- ----__--_--- - ----------------- Cesspool- i Distance ----- Siz _..Depth "`---------•-Liquid Capacity-I ------------------gals. 0 Privy: Distance.frorri nearest well_____________________________---_._.------------Distance from nearest building.-------- ---_------_-_____-_.._ F :.. ) ❑ Y Distance to nearest lot line = "' #Remodeling and/or repairing (describe):----A-ct ___, ------ s �(� `1 ,� _ V a A -------- y - ,--------- - --------- ----- S_ " ` . � __ -------------------------------------F----------------------------------------•-•----•-----_-----------••---_------------------------------------------------------------------______.__---------------------------------- _________________F______._,__._________r_-______________._____----._----__-------______.___-_-__----_.__--_-._---___--_-_-___-_------_-___-_�.-____ -_--__-_..-_------.____---- __ __ ----------------------- ----- - I hereby certify that-I have prepared this application and:+hat the work will be'done in accordance with San Joaquin County Q ' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.' (Signed)---------- " t - '�r ' ----- --1---N C '----- --------( wner and/or Contractor) By:---•------ �`'1 ----------t S - = ----------------------- (Title) ` . --�. - --------------- F of plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed an reverse side). At r ! 1 .r t FOR DEPARTMENT USE ONLY f{ APPLICATION.ACCEPTED.BY_... 4.5 W ------- -- --------------- ---- ---------------------------------------------- / cL _ 1 D DATEf =. /- ----------- REVIEED BY - ------------------------ --- ----- ---------------- DATE---- -------- BUILDING PERMIT ISSUED------ DA-TE t �+ ------ ----- ------------------------------ Alterations and/or recommendations____ _� 1 i, `�_ �.L i ._r r---_.. JE.S1'1-�5 ------------- �. - ' ---------------- -------` s I t ------------------•----------•--------------- ------------------------ I ----------------- ------------------------------•------------- -- t t { = - _. --------------------------- FINAL INSPECTION BY:-... �"'Z � ` Date_ ------------ ------------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Hoxelton Ave. 300 West Oak Street T 24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Californea Tracy,California E5 9 REVISED 8.59 3M 3-•63 F.P.CD. 1