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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ._-!}` .��. ----- -- (Complete in Duplicate) .................. This Permit Expires 1 Year From Date Issued Date Issued .- r 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 com 'ante with County Ordinance No. 549. Z2e-- /70._Z Aj r 3 l fQ 3 S. �?�+GL NE WA � � JOB ADDRESS AND LOCATIO_'N------_-.-j(;X_T_fV_�---"'"_V_- .----�---------/LIW/---- - Owner s Name----------- /WAPill.A------------;ZWA)R--►---r-------------------------------- ---------- - -------- - ----- Phone--_,- - - Address Contractor`s Name--------FLx 15__-K------------------ Phone-------..-------.-_------_ Installation will serve: Residence ff- Apartment House ❑ Commercial ❑ Trail r Court ❑ Motel ❑ Other s❑ Number of Ijvingmnifs: /--.--- Number of bedrooms 3--- Number of bath _`x-Lot size ...... Water Supply: Public system E] Community system ❑ Private �epth to Water Table -/a-_ ft. Character of oil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--.-------_--------) No New Construction: Yes J?I�No ❑ FHA/VA; Yes A No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic-tank or cesspool permitted if public sewer is available within 200 feet:)"- 5eptic k: Distance from nearest well------$70 --Distance from foundation-_---/Q-._--.-. Mater ia-T T' ~�^ �-----"-. No. of compartments-------�_.-_------Size-_Y-X_ta-57iquid depth____, - Capacity--12.90.--- /I Disposal Field: Distance from nearest well-----50-----Distance from foundation----/0--------- nearest lot line r-- _--.----- Number of lines-----------------------------------Length of each/5' 9 4 -.Width of trench 2 -----------f - Type of filter material_k _O-C. ---Depth of filter material-_P?--"-1.....Total length----------------- 0 Seepage Pit: • Distance to nearest well----------------------Distance from foundation-------------I--_-.Distance to nearest lot line_-.-------------- �1 ❑ Number of pits----------------------Lining material--------------------...Size: Diamete'r-----------------.:.---Depfn--------------------------------- 7 % ,w Cesspool: Distance from nearest well-----------------Distance=from foundation___---------------- Lining material------------------- Size: Diameter-------------------------------------Depth--- =_=---- -- =----- --------Liquid Capacity----------------------------gals, � N Privy: Distance from nearest well--------------------------------.......... .}_.-Distance from nearest building-------------------------------.-_-.---_. -� ❑ Distance to nearest lot line-----------------_-------- - ----------- s -q ------------------- ----------- ------------------------------------ Remode4ing and/or repairing (describe):------------------------------------------------------------------- -- Y - y -----------------------'----i-------------------------------------------------:-------------------------------i---------------------------------------------- ------------{-------------------------------- --------------- �� s I ------------------------------------- ----------------------------------------------------•--------------------------------------------------•------------------------------ ------------------------------------------------ 1 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]--_ -- . - (Owner and/or Contractor) ,_- - - i '�gY�----------------•................`�:-.-......-------------------------------------------------------------------------------------={Title)- -------- ---------------------- ---=------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- . Q-- -- - - --- - - ------ ------- ---------------------------------------- DATE--------3-n-2s4�--------------------- REVIEWEDBY------------- --------------------------- - -- --------------------------------------------- DATE------ ------------ BUILDINGPERMIT ISSUED-------------- -------------------------------------------------------------------------------------- DATE.-------- --------------------------------------------------- Alterations and/or recommendations:__---- ----- -----------------------------------------------------=--------------------------------------------------------------------------- ----------- ------------------ i t ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ FINAL INSPE l Q- Date------. _5_ --.2/:..vx--- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 724 Sycamore Street 205 West 91h Street Stockion,California Lodi,California Manteca,California Tracy,California F.P.CO. f