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-z C . _ ---- - -- FOR OFFICE USE: � :�-----� ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No: _ �� ------,: ' (Complete in Duplicate) a -Date Issued ------- This Permit Expires 1.Year From Date Issued t 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 compliance with County Ordinance No. 549. JOB ADDRESS A . LOCATION-----------�_3�5 _--------p -R �:-,---47N--�--------------+--------�l�T�}_��------------------------- Name----- rr ,/_ --- Phone------------------------------ Owner's . _ Dai- X02 L{3TF�o_ - = - Address----•---------- ------- € ------•--•-------- --------------- Contractor's Name-_1 -df--vif --------- --------------------------------------------------- Phonet r. Commercial E] Trailer Court C3 Motel ❑ Other Installation will serve: Residence Apartment House El _ Number of bedrooms 3.. Numberti'of,bafhs _ Lot.size __1 --x_-/4V------------------------ Number of,.living units: �__ �,� �.�-- Water Supply;;-P bis:system- Communit0-a m {].-Private ❑.•'Depth:to WateraTablel- -eft.,, .,. ...,I, ❑ i+y I ❑- Y -❑ Clay-O» ❑ Hardpan ❑ Character of soil fo-'a—depth`of31eet?_"Sandravel "'-Sand koam la 'foam=r •� Adobe' Previous Application Made: (if yes,dote ------- .-) No# ew`Cons+ruction::Yes �No ❑ FHA/VA: Yes @2— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS t • I s o'ol—permifted'ifT ublic iewer-is.avai 61e'within-200'feet.)�` -"- (No septic tank or ce sp p P # V No. of com artments_- Size__ °m foundation____) --------Mate ial____I �_1 ._ .- xC-T ----. a -----.Ca ac.t Septic nk: Distance from nearest welL��-- ' , Liquid de th- _ _Distance r ,I - o+ line-- '! -------- Disposal Field: Distance from of lin nearest well_._._.'---- ._)Dista h ofrom foundation)I _-_. ... istance to nearest h �` filter materia_ .G --.De Length of iteh'mater ±.� _ /cal hlength of french.- v-------------- p _Type,of p W Seepage, Ptit: Distance to nearest well.........-------------Distance fro m foundation----.-__-----:----_.Distance to nearest lot line--._-_---_.-_--_ N Number of pits----------------------Lining material_-- 0-----------Size; Diameter----------------- Depth= --------------------- ❑ 3 Cesspool: Distance from,nearest,well---------J4A--Disfance.from_foundation._, Lining�material_ - -------------- De th___-- Liquid It _ - gals. R �. ❑ Size: Diameter p F --- _. Priv Distance from nearest well ._ Distance from,nearest.building._ ---------------------------- Privy T. _ -------- Distance to nearest lot line---- #�!!t xt� _ ------ ---- ----------- ----------- ------------------------------------------------- i Remodeling and/or repairing .(describe}------------------------------------- -----•--_------------••---------- - � - - . '_ - - ----- -------------------- ------------ -------- t ---------- - _.. - ---- ---------- ' - - ------ -- ------ ------------------=--------------- ------------- ------------------ - - -------- I hereby cer;ify that I have prepared:this,applicafion and.-fhat the work will be done in.accordance with San Joaquin County ordinances, State laws, and rules and regulations-of the San Jo' uii Local Health Distric+. �J (Signed _.( ner and/or Con+racfi or) ---------- .----=----- (Ttt e ;jjjjj I ----------- (Plot plan, showing size of lac, location of sys+em.in relation to.wells, buildings, etc., can-be placed on�eve�rs FOR DEPARTMENT USE ONLY lDATE_..--- , " i __T_APPLICATION ACCEPTED REVIEWEDBY----------------------- ------------ --- DATE----------------------------- ----------- -----------•------ BUILDING PERMIT-ISSUED__ c--- �_ __ — _ �DA7E _.. ter: - b:: ,t - -------- - ------------- _ Altera_+ions and/or recomm_ ee ndati __-.__ons: ------------ ---------` ------- ---------------------------------------};'!_.!E- ---=---`-"r-- °'T!-me- -----="-rr"-`-""�`----•-------•---------- --------•------------------------------------------ ------------------- . - 4if/ t -0 A 1i is -------- --------------------------1.--------------------- -----__.__. "-_ ---------- . -------- ---------------------------"---------------'-------------------------------------..-.-------.-----------------'___._ - €' - - -- ---------------•-------------- -----------------`-`----------------------..._------------------- -------`---.- ._.......... .. ... ........... -__ ._____. FINAL INSPE B ----- ----- '- . ... . .. Date - - ^ 'F ----- SAN JOAQUIN LOCAL HEALTH DISTRICT l 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California i 65 9 REVISED 6-59 3M 3-'63 F.P.CD- �iyyL Zi +L: