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li <br />APPLICATION FOR SANITATION PERMIT Permit No. <br />(Complete in Duplicate) <br />This Permit Expires I Year From Date Issued Date Issued ........ <br />Application is hereby macle'%to the San Joaquin Local Health District for a permit to construct and install the work herein adi scribed. <br />This al:')'plicafiort is made in compliance_wlth County Ordinance No. 549. <br />, OS9 - ;_-6A0 — <br />JOB ADDRESS AND LOCATION----------- Ka,,t-_-Q_f ---- <br />R <br />N1, <br />Owners Phone <br />Name------- -- LQ-y.d,- <br />......................... -------------------- --------------------- ---------------------- ------------------------------------ <br />1822 :�S. Adelbert <br />Address ---------- i ..... <br />Contractor's .Name---------------'! -Roto ---- FLo_o.tP__r ---- Se -w -ex ---- Sex-vic-e ----------------- <br />-------------- -------------- Phone..R9 --- 5_n_2_61fa ------- <br />Installation will serve: Residenceb Apartment House E] Commercial E] Trailer Court []. Motel E] <br />1 Other ❑ <br />II <br />Number of living units: -J---- Numb;er of bedrooms --a_ Number of baths 1_--__ Lot size --- 162._.X_-_3.3-3._-_-----•-------------••.-----_ <br />Water <br />-62._X---3.3-1-------------------------------- <br />Wafer Supply: Public system E] Community system El Privafe;E] Depth to Water Table -4-5- ff. <br />1 <br />Character of soil to a depth.1of 3 feet: Sand E], Gravel Ej Sandy Loam EN Clay Loam n Clay [j Adobe [-] Hardpan ❑ <br />Previous Application Made: El No In NewConstruction: Yes Zj No L] FHA/VA: Yes ®No 1771 <br />' ' <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septic Tank:. Distancei.from nearest well --5Q .......... Distance from founclafion-10.f ......... Material --- C -Q ---- 5xi -_ c -_ k� <br />--- <br />L_TNo. of C'6mparfmenfs____2 ..... ..__Size 5-6'-X-4-01 _____________Liquid deph__4-:�_ ---------- <br />--- Capacity ---- 8.0-0 -- -------- <br />1I <br />Disposal Field: Disfancejrom nearest wltl�._ <br />I - 50 -'-_-Distance from founc1ation_____2_q_,, ---- Mistance to nearest lot line ---'--5-! ------ <br />U Number"Of lines___-__-_-_- <br />------------------- Length of each line___.JA�� .... #jF ----- Width of french. ---24" ------------ 100 <br />Type of filter material-1-21ia'ck -------- Depth of filter material ----------- Ia ...... Total length___-_-__-k.eV_4___ZAA9 <br />Seepage Pit: 0 1�'? log 51 <br />Distance' nearest wellicA00-1 -------- Distance from foundation____- --------- -- Disfa4ce to nearest lot lipe ---------------- <br />Numbe%fo pits --- 2, f Lining material_______-_- -,,e: Diameter_______________________ ----- Depth ... 25 <br />-------------- ----------- S 33 <br />Cesspool: Disfancelfrorn neatest well ----------------- Distance from foundation -- ------ - ---------- Lining material ------ - <br />E] r .1 ------------------------------- <br />Size, Diameter--------• -- � ---------------------------------------------------- Liquid Capacity---------- <br />;I - ------------ ------------- Depth ----------------- gals. <br />Privy: Distance from nea'49t-'Well --------- --------------------------------------- Distance from nearest building --------------- ', <br />0 ------------------------ <br />Distance10 nearest,lot line <br />------------------- <br />Remodeling and/or repairing (describe): ---------------- New Sentic S' <br />---------------- yA:I�e_m --------------------- <br />------------------------------------------------------------ ---------- -------- -------------------------------------------------------------------------------------------------- <br />--------------- ------------------------------------------------------------ <br />------------------------------------------------------- 1- --------------------------------------------- * - <br />---------------------------------- <br />------------------------------------ ------------ ----------- <br />------------------------------- * --------------------------------------------------------------------------- ---------------------------- <br />I hereby certify that I h"ave prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, State laws, and rules and regulations of the San Joa-quin Local Health District.` <br />(Signed}_____-- ----------------- a-0-t-0-11-RO&te-r ----------------------------------------- 1 --------- (Owner and/or Contractor) <br />By------------------------------- -- -- ----------(Title] Owner -- - ------------ <br />------ ----------------------- ---- --------- <br />c ion -o in relation to wells, ,etc., can be placed on ieverse side). <br />(Plot plan, showing size of lo ,y,;Wem i e is, buildi&;i <br />FOR DEPARTMENT,USE ONLY <br />APPLICATION ACCEPTED BY----- ------ -------------------------------------------------------------- DATE ------ - <br />REVIEWEDBY ------------------------ l'i -------------------- ----------------------------------------•------------------------------------. - - DATE <br />---------------------------------------- <br />BUILDING PERMIT ISSUED--- I ------------------------- * ------------------------------- - -------------------------------------- DATE--------------------------------- <br />Alterations and/or recommendations:------------------ -- ----------------------- <br />---------------- : ---------------------------------- I ------------------------------------------------ --------------------------------------------------- --------------•-------------------------- -------------------------- <br />------------------------- -------------------------------- ------------ I -------------------------------------------------------------------------- -------------------------------------- -------------------------- ------- <br />---------------------------------------- ----------------------------------------------------------------------------------- I ----------------------------------------------------------- ---------- -------------------------- <br />---------------------- ---------------------------- ---------------------- --- -------------------------- -------------------------------- ------- ---------------------------------------------- ---------------------- <br />FINAL INSPECTION BY-:. <br />------------- ----------- ----------------------------- <br />SAN JOAQUIN 'LOCAL HEALTH DISTRICT <br />130 South American Street II 300 West Oak Street <br />132 Sycamore Street 814 North "C" Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />II <br />ES -9-2M Revised 8.'59 F.P.Co, il <br />