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FOR OF!"ICE USE: <br /> -------------------------------------------------- SANITATION PERMIT Permit No. <br /> APPLICATION FOR ............ <br /> --------------------------------------------------------- <br /> - ---------------------------------------- ----------------- (Complete in Duplicate) Date Issued _=0121/4- <br /> ------ --------------------------------_L I This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> rrP <br /> Th' ap 1.cat ion icji <br /> s ma in compliance with County Ordinance No. 549. MT—CA A 41� <br /> V <br /> P�CK— - 6 <br /> 4 � /0- -15 — ----- ------- <br /> -------------------- <br /> R-6i.-F---------- <br /> JOB ADDRESS AND LOCATION ----(1-OTT <br /> Owner's Name---- •- -- - ---------- ----------------------- ----------------------------------- Phone----------------------------------- <br /> 6 ' . 14 1 <br /> Address--------- X------------;Z 3-7---- 7 --------------- --------------- ------------------------------------------------ <br /> ---------------�__. Phone............—--------------- <br /> Contractor's Name.----------- ------- ---­----------------- V ej <br /> Installation will serve: Residence Apartment House [j Commercial El Trailer Court ❑ Motel [3 Other El <br /> Ibedrooms --- Number of ba size <br /> Number of living units: ___ ___ Number� of baths /----- Lot ------------------------------- <br /> 4 <br /> Water Supply: Public system 0 Community syste Priva+eepfh to Water Table <br /> Character of soil to a depth of 3 feet: . Sand ravel El Sandy Loam 1-1 Clay Loam [D ClayeQj Adobe U Hardpan <br /> ❑ <br /> Previous Application Made: (If yes,date--------------------) No Construction: Yes <br /> 2-110 0 FHA/VA: Yes 0 NoEj <br /> TYPE OF INSTALLATION AND SPECIFICATIONS <br /> sewer.is availab 0 within 200 feet.) <br /> (Noselpfic tank or cesspool permitted if:public <br /> Distance from nearest well_____- 4 <br /> Septic Tank: A rom f8uncla.tio ri_�---_______________.Material-____------___-______-._----____r'____--_-_---_. <br /> --------- - -------- ---- ------I_U!iclbicl depth--------------`1,;......Capacity----------------------- <br /> No.�of compartments--------- Size- <br /> ti <br /> Disposal Field: Distance from nearest well._.....5-0-Distance from found --------Distance to nearest lo'f line----S-------- <br /> Number of lines----------- -___Length of each line__l -- ...........Width �f trench- 36 --------- - <br /> y-pb- g ..15------/------ <br /> T material--- i of filter m"fe, I--------2 'n length_---- 7 <br /> of,filfer le I <br /> e foundation-----------r_1-_.Distance to nearest lot line_________________ <br /> Seepage Pit: Distance to nearest well_-__-_.__ ------_Distance from <br /> El Number of pits------ -------------Lining material--------__ _1--- Size:r Diamete'r-----------------I---- Depth-------!--------------------- <br /> ce from foundation -I i 11--------_J----------------------- <br /> Cesspool: Distance from nearest well___ -Dista ounclation-----------. _,_Lining m; ater a <br /> 'M q-r - -,,-I B!0 1 J�- I Liquid Laplacity---------- gals <br /> 0 Size: Diameter-------- ---------_-------- ----m_mll)e th-------------------------- -------------------------- ------------------ <br /> p <br /> re from lnea <br /> Privy: Distance from.nea ' st well__'__*'� rest building----------------------- ------------------ <br /> Distance to nearest lot line------------------------------------------------------------ -------- --- ------ ------- -------------------------- <br /> ❑ <br /> Remodeling and/or repairing (describe)___________________________ _____.__- -------------------------------------------------- .........------ --- ----------------------------------------- <br /> ------------------------------------------------- -----------A�-•--------------•--I- --------------------------------- <br /> - ---------------------------------------- ------- -- <br /> - ---------------------- ------------- ------ <br /> FI --------------------/---------------------------------------- ----------------- ------------------I------------•--------- <br /> ------------------------------ ----- <br /> Q------------------- -------------------- <br /> ---------------------------------------------- ----------i--------------- ---------------------1-1*----------------------- ------------------------------------ I------------------- -------------- <br /> I-hereby certify that I have prepared-tbis`appfirRjn�that fl�e ok will be done in accordancep.with San JO'aquin County <br /> ordinances, State laws-, and rules and regulations of +ke-&an Joaquin Local Health District. <br /> _ - ----------------------------------- ------------------------------------- -- -1.-11wrer and/6I r Contractor)(Signed)-----i- -- - ------------ -- ------------------------------ - (TitBy:--------------_------------------_- -------------------------- lel--------------------_------- - ----------- ------.--------- <br /> _111_1 <br /> G_.(P1a­pIan�, sIf6-Win§ size' 'of l6t, location of system in relation to wells,`buildings,-efc-, canbeplaced on rev6irt&'ticib)j <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----.-.-{ _-R-01------- -------------------------------------------------------------- DATE----- ------------ <br /> DATE----------------------------- --------------­------- <br /> -------------------_ <br /> REVIEWED BY--- ----------------------------------------------- ----------------------- ------------------------- <br /> BUILDING PERMIT.ISSUED-....... ----------- <br /> ------ DATE-----`-"= = -------------- ---------- <br /> Alterationsand/o� rec&nri-t6fi-daitions:---------------------------------------------- ----------------- -----------------------------------------•-------------------•-•-------------------------- <br /> ----------- --------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------- -w— * 1 1 : I - <br /> ------- --------------------------------------------------- -------------- -------- ------- --------------:------- <br /> --------------------------------------------------- ------ ------- --------------- --------- <br /> ---------------------------------------------------------- -------- <br /> ------------------------------------------------- - --------- ------- - ---------------------------------------------- <br /> ----------------------------- --------------------------------------- <br /> .-_-•------------•-----------------------«-_.I ------ ---------------"-- <br /> - - --------------- ----------------------------- <br /> FINAL INSPECTIO - _.- .- - .. .. - fi-- ___ Date-------- <br /> .--------- -------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Av*. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lod!,California Manteca,California Tracy,California <br /> 9 REVISED 8-59 3M 3`63 F-0-120- <br />