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APPLICATION FOR — ANITATION PERMIT Permit No. ... * {Complete in Duplicated This Permit Expires i Year From Date Issued 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-----------360 San Rafael Owner's Name------------------RO-SS___and- Rosa. Frank Ho. 4-3147 7 , ----------------------------------------------------------- ----------------------------------------- Phone.----------------------------------- Address-----•--------- 3 Q4 San Rafael -- -- ---------- -----•------------------------------- Contractor's Name----------- }e 2:"R�TJ C Tank- Service, Inc. Phone ...HO. --1----� � 1 �--- 9 Installation will serve: Residence I] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -__1_ Number of bedrooms _3x- Number of baths -1---- Lot.size -------Z5---X---2 ------------------------------ d Water Supply: Public system 91 Community system ❑ Private ❑ Depth to Water Table 45-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Z Hardpan ❑ Previous Application Made: Yes ❑ No Q New Construction: Yes 0 No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: } (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--- ---------Distance from foundation-------------------Materiai----------------------.-------------------------- Ex[X s'l ing No. of compartments--------------------------Size----•-------------- ------------Liquid depth--------------------------Capacity--------------------•-- Disposal Field: Distance from nearest well.................Distance from foundation------------------_.Distance to nearest lot line_--_---.-_----- E?�4tlrig Number of lines-----------------------------------Length of each line--------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------- .�� ----------- r b\ Seepage Pit: Distance to nearest well-------nO____--_-Distance from foundation--1Q- Distance to nearest lot line----- ---------- ET' Number of pits-------- ------------Lining material------T'OGk-----Size: Diameter--------36"1-------Depth---?�_r___max„___-.__ Q I 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------------------_----_.-.__- ` ❑ Distance to nearest lot line- ------------------------- I- ------------------------------------- Remodeling and/or repairing (describe)-------------- SACT. n? _._F Z- - Y'.�13PG--- 4--- a'41212---S,y-S 9M...--------- ------------------------••------------------------------------•----------•-----•------------------------------------------------------------------------------------------------------------------------------------------ - - ------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------- -------•--------------------------------- --- ------------------------------- --------------------•-------------------------------• -------------------------------------------------------------------------------------------------------------------- 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. (Signed)----------------De17'.8_-_S eT?t 1 C:._T-ank__Service ,_ _ Inc. [Owner and/or Contractor] a -------------------------------------------------------- By:------------Perre- 0,.---Warthan ------------ [Title]-------Gen. -Mgr'------------------------------ (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 APPLICATION ACCEPTED BY--jgf----Q--- - ----------------- ------------------------- REVIEWEDBY---------------------------------------------------------------------------------------------- --------------- DATE------------------------------- ------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------—--------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:------ ---------------------------------------- ------------fi----...-•--•------------------------------------ ---•-••----•---------- --- -------------------------------------------- . � 1 -r`--- -------------- -- -- ------- -y `! --- --- ------------------------------------------------------------------------------- ----------------------------------------- ---------------------------------- f FINAL INSPECTION Date_-__ 3- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stree+ 300 Wast Oak Streat 132 Sycamore Street 814 North "C" Streef Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F,P.co. 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