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FOR OFFICE USE: z I ------------------- F permit No. - --�'S-��__ _ APPLICATION FOR SANITATION PERMIT ------ - --------- {Complete in Duplicate) �d l --- - Date Issued -------ft.•�... _- This Permit Expires 1 Year From Date Issue ; Ds� - 2_5r0,-,6 S' 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 liance with County Ordinance No. 549. T _ }-�tr� �Ks S _ _tr _ ------------------------ JOB ADDRESS AND LOCATION.... _�L------ - ----a -)-Owner's Name _ / r_0_13 R-E T--=------------:---------------------- Phone = Address-"--------------------( 1!t ..--------------- -------- -•------------------------------------------------------- ------- Contractor's Name = -5-_Z1------- Q-lS--------1-MCI------` ---------------- Phone.. Installation will serve: Residence Ig Apartment House ❑ Commercials[3Trailer Court C1 Motel E] Other [I Number of living units: Number of bedrooms t3-__ Number of baths A� Lot size -------2.0------- --------------------- Water Supply: Public system ElCommunity. system ElPrivate 0 Depth to Water Table _-40- ft. 1 Character of soil 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 [ No E] FHA/VA: Yes E] No% TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200.feet.) -- - Septic Tank: Distance from nearest well'-_401D.---- Distance from foundation---., at�al-c-� ----------_- --------------------- M J .ter .-Size_ .�G Ir-----Li uid depth---•'r 3..----------Capacity. . uA No. of compartments � - �---X-- •-- q . Disposal Field: Distance from nearest wel ,l-- ___._Distance from foundation___ 5P....-_--.Distance to nearest lot line__._/�---. (� Number of lines_____________?�---------:------Length of each line-_---------«�.........Width of trench---.----__-_--`.�— ---------- Type of filter material---�FM_K-----Depth of filter material------ -.--__Total length----------- ---------- -- -• Seepage Pit: Distance to nearest well--l ---------Distance Tram foundation----75-7 __.---.Distance to nearest lot line_---7 ._�__. Number of pi#s.-..--- ._- --Lining material-- ---_-�8- ----Size: meter--------- Depth-----------------� --- ----- 10 Cesspool: Distance from nearest well-----------------Distance from foundation.--------_---___-..Lining material___.--_-__- ____.- ___---_--.----- ❑ Size: Diameter-------- --------------------------- Depth-------------------------------------------------- Liquid Capacity gals Privy: Distance from nearest well-------__------ _--- _;----------t7--------Distance from nearest building.-;_------------------------------------ ❑ --------------------------------•--------------------- .r Distance to nearest lot line-------------------------- - -----•---------'--------------- Remodeling and/or repairing (describe:---- € �Rh E C71-4----------'S ----�t'�� ------ ------------------- - --------------------- --------------------------- -- -------- G ---------------------------------------- _______ ---------------------•-------------------------------------------- ------------------•--------------•------------------------------------------------ I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin ounty 0 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. dj (Signed)- ' ` ----- --- and/or Contractorl ------------ RC � '`'``` - ----=-- ----------------------------------(Title)------ --- .c. ' r . (Plot plan, showing size of kat, location �syysmin relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---------------------- DATE--- -d__ -c -'G3 _ ------------------------ REVIEWED BY-------------- ------------- ---'---------- ------------------------------------------------ -------------------------:----- DATE------ ----------------------------------------------------- BUILDING ---------------------------------------------------- BUILDlNG PERMIT ISSUED------------------------- ----------- ----------------------------- -- ----------------------------- DATE--------- --------------------------------------------------- Alterations and/or recommendations:---------------------------------------------------------------------•---------------------------------------------------------------------------------------- -•---------------•--------------- ------------------------------------------------------------------ --------------------------------------------------------------•---------------------------------------- -----•---------------------------------- --- ------•---------------------------- --------------------- ----- �-- 9 FINAL INSPECTION BY _, =a��.•� .--f-----• Date --------•------------------------ --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-59 3M 3-'63 F.P.CC.