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FOR OFFICE USE: fs �--- --- 7 '�.: Permit No. 1-ZdM...... e APPLICATION FOR SANI'�ATION PERMIT - ------------------ ------------ ;,-� (Complete in Duplicate) Date Issued .-Q1--e � + This Permit Expires:1 Year From Date 'Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work` erein described. This application is made in compliance with County Or inan e N . 549. . " } 4S �c ---------------------------- JOB ADDRESS AND LOC TION.___. -- ----- - ----------------- I ---- Phone------------------------•----------- Owner s Name- ----- -- - - - ------- -- ------------------------ ------- xt- Address--•---------- ----------• ----.......� ------------------------------------------- T-3 -----•--•+------------------------••---_ = T� --•-------------•---------•---------•-- Phone Name---------- Ph 4 h Trailer Court ❑ Motel ❑ Other ❑ „�dristallation will serve: Residence [Apartment House ❑ Commercial ❑ ��-X !o O ----- ----- --- Number"of living units: ---L_- Number of bedrooms __.___._ Number of baths . of size _______ __________ _ ---- �;_ Wa��r supply: Public system n-Community system f-1Private F1 of to Water Table -9-0 ft. Adobe, ardpan ❑ .,E Charac-4er of soil to a depth of 3 feet: Sand F] Gravel ElSandy Loam ❑ Clay Loam ❑ Clay ❑ p PP FHA/VA: Yes El No [�}� is Previous A lication Made: ll#yes date_-.-------------- -I No L'�1 Ne`"� Construction: Yes o ElF. II �,,T_YPE OF INSTALLATION.AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) --------------"Material---/ ---------- r stance from foundation-/O l*, Septic' Tank: No}aof e om artmentst.Weil-� Size..__3_ _��x -----Liquid dep k---- _+--------------Capacity--•-S�p�`� P F Disposal field: , Distance from nearest well.:.._''------Distance from foundation.-�Q-f---------- [stance ih ofttrenches�� I`e_�__.___--�� t Number of lines d� ------------- & __ --- __Length of each line-76-7------------------- �'ha.C•��_ __Depth "of-filter material--.��-'--------Total length________---d =- J � � : Type,of-filter"material"_-TP__. _, o� S _-_/_a__-___.---Distance to nearest lotiine--`j____------ See a e Pit: Distance to pnearest _Linin 'material 1m foundation1� e: Diameter__.___3.3 Depth-.--- z O 4- Number"of its--`----- g. 1' Cesspool:�'� Distance from nearest well-----------------Distance.`from foundation_______________ __Lining material_. -------- -------- Size: Diameter-------- --------------------- ------Depth-----------------------------------------------------Liquid Capacity------------ - -------gals. Distance from�riearest well-.__---_ --------------- --1-----------------Distance from nearest building.-----------------------------=----- k Privy --- EDistance to'nearest lot line-------- ------------------------- ,.' Remodeling Ali/of repairing (describe):__--._._-.r-------------------------------------------- I --------------- --- - ------------------------------------------------------------------------------ -------------- t1 -----=-------=-------------- ------•----- --------------;.-....---- -- { - - -----------11 - - ---------------------'-------------------------------- ----•-_ ' ----•----'------` -------------- hi- ---- - ------- ---It----I------------------ t`--------------------------------- ----------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, the San Joaquin Local Health District. State laws, and,.ru s•and regulations of,F r (Owner and/or Cont (Signed 9 • S ?S ----------------------- (Signed)- . #. - `: - - # --(Title)------------------------------ ------ Plot p lan,^showing size of loft, location of s ste In relation to wells, buildings, etc., can be laced on reverse stile. I p ! l FOR DEPARTMENT USE ONLY # `/ - = DATE-- s ! .__� �`-- APPLICAT{ON ACCEPTED BYt---- __Yr. --" - i 2 DATE REVIEWEDBY-------------------------------- --------------------------------.----- ------ -------------------------- - ---- DATE------=---------------- ----.-------- BUILDING PERMIT ISSUED_.. 3Y^y tr. .. K ` =' ~ r— `=` I- ------------- ----------- � "' �- ' Alterations and/ recommendations:.__-_.___-.___ -- [ r a- ----------- -•---`------------•------------- •--- ------------------ i - ------------------------------------------ •------ ------------ �----- - ------------------ --------- + --------------- ----------- --------•- ------- ---- ------------------ C + ,...-�...-..r—.- ------ -- _"_.'1----------- � fNJOAQUIN -- -------=•-- ------ Date_"'"'-.:`3-- �----- - . � FINAL"INSPECTION BY;.-- -------- S LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 30k Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 0.59 3M.3-•63 F.P.C4. l _.