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FOR OFFICE USE: -------------------------- -------- ------------- ------- I APPLICATION FOR SANITATION PERMIT Permit No. _1 .3• . { � 1 (Complete in Duplicate] ---------------- , Datefgsued � 3 --- (0 ---------------. This Permit Expires 1 Year From 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 LnO�CATION---= -�'Zf� - ---�'' _._.Cl -----t�- ® Owner's Name- = �f—R-S-•- -�eo1 - Phone..-------------------------/ Address - [±n T� 1.. p Q _ - 14 ---------------I---------___---- Contractor's Name Tff-------------------•-•--•---------- Phone------- --------------___--•------- Installation will serve: =Res`iclence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i l Number of living.units:1_P_-_ Number of bedrooms ___t____ Number of baths __.(____ Lot size -----JO __________________ Water Supply: Public;system .E] 'Gommunity system ❑. Private Depth to Water Table 3S-- ft, r Character of soil to a depth of 3 feet�and E] Gravel E] Sandy Loam ❑ Clay Loam Clay C) Adobe C] Hardpan Previous Application Made: {If yes%date__________...___.__-._1 No New Construction: Yes fNo ❑ FHA/VA: Yes ❑ No Wj-' TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or.cesspool permittedif public sewer is available within 200 feet.) - _ Septic T Distance from nearest wa k__5_0, __Distance from foundation___ __ p ---Liquid depth �istance --- - acitY `��--G-flGS . No, of com artments7_- _.__Size._ �p -________ Disposal ield: Distance from nearest well,__g4_.---.-Distance from foundation._--- - -- to nearest lot in;t______________ Number of lines--------- __ ��---------____--Length of each line--------��------------Width of trench--------1-7-t-----------r------- Type of filter material__ ?d_ _____Depth of filter material____ __ ____________Tota-11Rlength___._____________-_50_.__---______- Seepage Pit: Distance to nearest well---- - from foundation__ __ _ Distance to nearest lot line--�---__-__ o 1 Number of pits.J---/-------------Lining mate rial._��_____x..�ze: Diamet ---------.Depfh-..._/Q----------------------- Cesspool: -- ------ i- - --------- Cesspool Distance from nearest well____---____l Distance from foundation....___._________Lining m`ateciaL "' ______________________________ [] Size: Diameter_ -= _'Depth = Liquid Capacity- -------------------------gals. Privy: #. - Distance from.nearest well.____-___ ________________________________Distance ,from nearest building------------------------------------------ 'fir ❑ Distance t y t Gnel ' � . _ �' Remodeling and/or repairing (descrik�e).__!s��._¢ R _I�_ � _____:C613� _____ 'v___ ___ �+ 0 �_S_H�. .. tN�_I-"Tt-t1. ='np #iT_94_x`_S__e------ FoF. IriR_rC147`a-13----1-At ��rti_r�I-=v� EYt�?S._ �.NTR �4'rr[?. ( ART �- ' r9-c �.s- rR_RF ------- ---------- t P Q,t 11AR ,A p K-p�IV ---� o_09;----cFaNa�r� --------- ---`-IR-• -- --- -------- I hereb certif that 1;have,, re ared this application and that the work will be done in accordance with San Joaquin,County ordinances, State iew , ' rules and regulations ofithe!Sa.n,Joaqutn,Locai Health District. ` {Signed) -- ---------------- ------------------;------------ -------------(Owns ;and%_o`rContractor) BY'------ +-:---- �:;- ---- -----_--------------.------------------------.------------ -------------(T' le)- --------------------- ------ c',h It r (Plot pian, showing size-of-lot,.location of system ln.relatlon ao wells,.}buildings,..etc., can.be,placed on reverse,.sicle).,.— C I FOR DEPARTMENT,.USE ONLY .r.. APPLICATION ACCEPTED BY ----> �-Q-'------------------------------------ -=-- ----- -- DATE - ___---- ------r------------------ o REVIEWED BY-------- -------------------- - fi- #� AM-^.---------------- DATE --- ------- --------------------------------------- - -------------- - � ----- BUILDING PERMIT ISSUED =#- - :: . 'k ---- r--------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:--- - r/- P-------5A --------------------t_R=ON------------- -------------------- t � t t w I .,.�....r... FINAL INSPECT ------ -�-- � y D�---------- - --------- �{ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California C6 9 REVISED a-59 3M 3-163 F.P.CC. - - - I ,