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FOR OFFICE USE: <br /> -------=----------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. ....... ... <br /> ------------------------- ---------------- (Complete in Duplicate) Date Issued ---6-3 <br /> ------------------------------------ ------- ------------- - This Permit Expires -1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance'No. 549, <br /> 2 A -- ------- ---_--------------------- <br /> OB ADDRESS AND LOCATION....._, ......"Ram---C.�........777.� <br /> ft <br /> J� <br /> Owner's Name..-,)?--r---- ------- ­-------------------------_. <br /> ---- ------------ ------------------------------------- ------ Phone-re-,.F!gr <br /> Address----- F -A.Y...6 Z e---—------46 C,1;r le V q 70 <br /> ---- ----- -- <br /> Contractor's Name----09elwle------ <br /> ,1yoff4i------------- .. ........ phone. <br /> Installation will serve: Residence & Apartment House [:1 Commercial El Trailer Court 0 Motel C-] 'Other ❑ <br /> Number of living units: Number of bedrooms -,Z--'Number of baths A--- Lot size47-a-e.e.op---C------------------------- <br /> Water Supply. Public'system ❑ Community system [1 Private [4 Depth to'Water table:35 ft. <br /> Character of soil to a depth of.3 feet: land D . Gravel C] ' Sandy Loam p J t Clay Loam [:] Clay ❑ Adobe C]j;Ha4rdn <br /> -Previous Application Made: (if yes,-dateN--------------- ) No R- New Construe! No <br /> N +ion: Yes:E] No E]- FHA/VA: Yes El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No septic tank or cesspool permitted'ifspublic sewe.r:is�_availqble within 60 feet.) <br /> 11 0% �- <br /> Septic Tank- �jol)isfance from nearest well__�S_'#-. :Distance�rM V�SXndJljon---1-6------------Ma'�t_e r M,I'CO _F_T!i;Z—-------- - <br /> -'�'pacity 7 <br /> ET�2,1) No. of compartment - ------ 2--i��--"Liquicl depth- C -0-92 <br /> /* -190 <br /> Disposal Field: Distance from nearest well---%6*-O-"IDisf�nceXfr7c)mFoundatiln---�/O----!____Disfancekfo4n'0e'aAbsf lot line_Z4_/ <br /> 1, . - W- -- , -------- <br /> Number of lines------------- z, __i��Le;�g-fk of each-line -/-f4-`.Widfk of trench-------__2—'/_______________ <br /> Type of filter.material___7?,0_0(___ADepfh of�'fiilter material-l!i!---/.I-----------Total- length-------/400_,�' <br /> ­-------------------- <br /> Seepage Pit: Distance to nearest well--�eo ------Distante from f6und-aTion Distance to nearest lot irie_/4---------- <br /> Number of pits.____,-----7--Lin-ing mai-erial'-_04-Ce---- Size: -. ____-.._._.____ ti Distance from,' Sf we Distance from foundation___________________ Lining maferia1_____"_7.._1_ -----1.------ ---------- <br /> s nearet, n <br /> ------------------------------ ------------------------------------ <br /> 0 Siz:e: Diameter---- --'Depth-------------- Liquid Capacity- =--,i--- f ---------gals. <br /> Privy: Distance from nearest well----------------=--------------------------------------------------------------Distance from nearest building--------------------------'-------------- <br /> ❑ Distance to nearest lot line.---- ------------------------__:------------------------------------------------------------------------------------------------ <br /> Remodeling and/or repairing (describe):------ ------y M---------- <br /> 4_M_41__tZX9,q;A1----6-.6-S-e- �-----------------'A , _ ,;. .— V" <br /> --------------------------------------------------------------------------------------------------- ----- --------- <br /> P 1r P_ <br /> -.77 __ n�__ T- --F-=------------S'1657.157FA16---_' -.1 _Aij--------- ------ ------J__.- <br /> ----------------------- .... W ------SEJ��---------- _z- 6iv A <br /> ------------------------------------------------------------ --------I------ ......----------------------------------------------------------------------------------------------------- <br /> I hereby certify 4haf I have prepared this�sws, a""'lication and that the Work will be done in accordance with San Joaquin County <br /> ,IPPordinances, Statand rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----- ------ _Z�=_(Owner_and/or -Contracforj.� <br /> -------------- <br /> Pia <br /> ----------------------------------------------------- <br /> - ;V � A I& A F.. ...... .....V P <br /> (Plot platin, sho,wingl size of lot, scion of system in relation to wells,.buildings, etc., can be pla�ced on reverse side). fi <br /> ar* FOR DEPARTMENT USE ONLY <br /> y <br /> '�,TIQNVACCIPTED By---(—, <br /> APPLIC .�Y�u __ -R-0---------------------------------------------------------------------- DATE----- --777� 4/ - �;-'•fi-r-------7_ 7� <br /> REVIEW�D ----------------------------------------------------------- -------------------------------------------------------- DTE------- ---------------------------------------- <br /> BUILDIN' ISSUED_------------ --------:---------------------------------___:----------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations------------ ----------- •--------------------------I------------------------------------------------•---------•----------- <br /> ---•-.----- <br /> -•------------------------------------------- <br /> --------------------------------------------------*------------------------------------------------------------------ ----------------­­------------ ------------------------------------------------ -------------------------------- --------------•- <br /> --------------------------------------------------- ------------------ ------------------------ ----- ----------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------- ------------- --- - -- ---- ---- ------------------------------------------------------------------------I——---------------------------------- <br /> - -- - ---------- <br /> --------------------------------------- -------- - ----- - ----............ ---------------------------------------------------- ------------------------------- -------------------- <br /> ----------- <br /> FINAL INSPECT ...... RO----- Date._.._...----___- ---- ------------------ ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockt*nr California Lodi,California Manteca,California Tracy,-California <br /> CS 9 REVISED 8-59 3M 3`63 F.P.00. <br />