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.�U"ICE USE: - --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ?- _7 --- —(Complete in Duplicate) T This Permit Expires 1 Year From Date Issued Date Issued5=- � I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descri�b�d. This application is made in co liar ce with County Ordinance No. 549. JOB ADDRESS AND LOCATI N ;. '=-t. ---- QF} Q ----------- 4 Owner's Name-------- A_R_l--c. _ - -----. Phone ` rAddres s_----- 5 !�/_ - } C ,w. --------------------------------------------- Contra'ctor)'s I f "{ ----------- one-------- Ph Installation will serve,,� Residencelff Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel �;% . ,.� ter- �..._ _,., ❑ Other ❑' Number of livingunits -- umb�be of,bedrooms._ _--.Number of'bathsf---__- Lot size _ 14CJ •" N Water Supply: Public system ❑ C'6mmUhit�-syst6rn--❑—Priva#e'❑Depth to'�Water Table _x____ ft. Character of soil to a depth of 3 feet-Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam f ; Glay ❑ Adobe❑ HardpanIr [ Previous Application Made: (If yes,dat_ --- ..--------) No �ew Construction: Yes ,[ No.:E] FHANA: Yes El No ❑ TYPE-OF--INSTALLATION AND`SPECIFICATIONS: (No septic tankFor cesspool pernsifted if public sewer is available within 240 feet.) # Septic Tank: Distance from nearest well__6_�___:Distance from foundation__`" � un --•-- Ma eri ! � --C_�eZ7 No, of compartnierits_. . ---Size X� _XLi Liquid de tI"_ . ___ 1 t I = q p. Z Capacity.._ l Disposal; Field: Distance from nearest weil_._.� � Distance from foundation----IC, --__ _Dis+ance to nearest lot Number of lines._ n_".-"._---__--""----Length of each line_____74, YP , p X Width of trench. --- ----------ry T e of filter ma$erial___ _ y- Y - _ "L?.�..�_De gh of filter --- - -- t>�_.Tota! .length---------�,�'-/-------;_�� Seepage Pit: Distance to nearest well_._ff ""_____Distance from foundation""_.� tj ------ Distan e to nearest lot line___________ Number of pits---�_.�_ _"" Lining material_ _`t1G j•� Size: Diameter I �j b- ".?._ .---Det i i3ir+1 ' Depth .tom -- --- ---- Cesspool: Distance fr nearest well Distance from foundation---------------------- , i At_„" .i rLm'rng material-----❑ Diame ter----- --- - - Dep�Fh------------------------I-----------------------� Liquid Capacity--- ------------------------gals. Privy:- Distance from nearest well-_:___-"_.__ _ D stance-from n�e&est• buildin i ❑ Distance to nearest lot line--- ----------------------------------------------- Remodeling and/or repairing (describe);,_- --------- -------.---- U ...« C ---------------------------------------- ----------------- ------------•----------------------- ... ----- , ----- ----------------t ..-------•----•----------------------------------------------------------- -------- ------------------------------------------------- I --------------- --------•---------------------•--------------------------=----------------------•-------- ------------ --------------------- I hereby certify that I have prepared this application and that the work will be donein accordance with San Joaquin County ordinances, Ste laws, and rules a der latio of the San Joaquin Local Health District. r (Signed)- E/� ----------------------------------------- R. rik4 k -- ---- ----- ----- - -- ---- - ------ -- �•---Ra.�-,-.�,.�._ .�:;,..... �;�,r" _ ---- -_- "".""." caner and/or Contractor] By:--------- ----•---------- _--,.r ;� --------- _(Title) "' ; (Plot plan, showing size of lot,.locatioh of system in relation to wells,lbuildings, etc.,.can b).placed on reverse side). # FOR KPARTMENT USE ONLY .: -------- DATE_C APPLICATION ACCEPTED BY----- -•- _).iR.-Q" r---------- ------ ----------------- REVIEWEl7 BY---- ------------------------------- -F"-- -- DATE---•- - ------- --------------------------------------------------------------------- ------------------------------------------------------- UILDING PERMIT ISSUED • = moi- =-------- ----- --_=:.DATE..-=--• = -_-_ Alterations and/or recommendations-- --------------- ---T - ' m - -- — �. - - --------- `. ^ 'o ±Tip;E'PTh�S+-- -......--.�`tj----S4Zvi).---�-�'41Z--CY ---------- -- ------------------------ ------------ ------------------------•---------------- .------— ............. ... .. -------------- --------------------------- - ' —--------------- ------ -------- --- i FINAL INSPECTi4'N_B /,, ( Date--- s •� `' # SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-•63 F.P.CO. y �, v