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APPLICATION POR,-ANITATION PERMIT Permit No, .__7_. ..... (Complete in Duplicate) -yy Date Issued 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 AND-LOCATION______Western_-Pacific R. R. Xard�rPacific Fruit Express Owner's Name--------.-`_Paci—fle-_Fruft__.Express---------- --------- 1- - .. Phone---Ho. 6--7-1-4-1.--, Address--- haXppS---LaI7.0__..�Q.._ ---vurn--- r----and -cross W._, P_sx1flc bridge, turn left Contractor's Name____ - and continue to wash house 'an sial! Of h].aCk'top road 1 _ta- '_----------•---------------------- -------- -------- ---------- ------------------------- •----•--- one_- ._.. ------• _ Installation willwill serve: Residence ❑ Apartment House ❑- Commercial ❑ Trailer Court ;[] Motel [❑ Other awash house Number of living units: __0___ Number of bedrooms ._g_.. Number of-baths .-P-_ Lot size __Wester Pac. R. R. '0+0„-'v -- - ----------------------- ------------- Wate�oSupply:. Public system ® Community system ❑ Private ❑ Depth to Water Table35___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loom El Clay Loam ❑ Clay ❑ Adobe E] Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) yam` --- rio_____Distan e n Nundat 108 teria------------------------------------- Septic Tank: Distance from nearest we�______ _ ion_--- CI No. of compartments------- ----------------Size9_ X -- -----------Liquid depth------ ------------ Capacity$-------------- Disposal Field`. Distance from nearest weli-----------------Distance from foundation--------------------Distance to-nearest lot line________--.______ ❑ Number of lines-----------------------------------Length of each line-----------------------------.Width of french._---------------------.----------- ` + Type of filter material-------------------------Depth of filter material----------.------------Total length------.____-____-____________________.____ Seepage Pit: Distance to nearest well bk_____________Distance from foundation_l0$t*_._..Distance to nearest to I' �___5____-_.._-- [4 Number of pits._._-__.l___..... __Lining material-_rock 30 --.Size: Diameter --------------Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material------------------------------- ❑ Size: Diameter------- --------=---------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well............._.______.-____._____..__________._Distance from nearest building__..----______._______ fi ❑ Distance to nearest lot line------------------------- ---•-------------------------------------•--- •---------------- , 4 _. Remodeling and/or repairing (describe)_______________cne' one.—cell _.,_Septjc and one rook--filled seepage pit �, i' --------------------1k alt ... &F.Qd---in_-_cele ocl_-:and to be used for washing;-�up after work, e�_c. i ._onl y------------------------------------- -------------------------------------------------------------------- -------- ------------------------ ------ ------------------------------------- ---- ----------------------- -------- ---- ------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Delta (Signed)------------ -------•--•----------------------------------- ------ ---------------------------------------------------------------------------------------(Owner and/or Contractor) By.........-----_----�'-'� -------------------------------------------------------------------------------------------- -----(Title) .Gen,.Mgr' - 4 `1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTEDBY-•- - --- ----------------------- - ----------- ---------•-- ----------------------•---- DATE. REVIEWEDBY----------------------- ----- -------- ------------------------ --------------------------------------• DATE__ -- ------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------is--------------------------------------------------- Alterations and/or recommendations:------ ----- --------------------------------------------------------------------------------------....--------------------------------------------- -------------------------------•-------------------------------------- --------------------------------------------•-----•--------------------------------------------------------....._..---------------------------.._-----• -------------------------------- ----------------------- --------------------- -- �.FINAL INSPECTION BY:.----- --------------------- -- ---- -----------•-- . Date----- - - -- -- - -------------------------- -----------------..... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South_American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street } Stockton, California Lodi, California Manteca, California Tracy, California E5�9-2M 1-05446 Al-.DD 12-54 '