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FOR OFFICE USE: -------------------------------------------------------- l ------------------------- ---------------------------- -- APPLICATION FOR SANITATION ,PERMIT Permit No. -1-/7,a_Q- ------------ -- ----------------- ---->------ (Complete in Duplicate) li / : ._ ---- ------- Date Issued -------.----------.----------------------------------.... 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 ANDLOCATION__�1 a7_ _G f----7E.C� -----IVP---�I" AN-77---------------------------ORN_T ------- Owner's Name---------f---_t_.F------ ReD ----------------- --------------------- ---- Phone--------- -------------------------- Address--------------7-f..'--------- -_---------MIR-1-4TlE Contractor's Name-- -------- AR-C 1 - - Phone Installation will serve: Residence ❑ Apartment House El Commercial Commercial L] Trailer Court E] Motel ❑ Other Number of living units: 3--- Number of bedrooms __f7--- Number of baths I3 __ Lot size ______________ Water Supply: Public system ❑ Community system 2"krivate ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ 'Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------__,---.--_1 NojZ"- New Construction: Yes ff'lNlo ❑ FHA/VA: Yes ❑ No Ef"_ TYPE OF INSTALLATION AND-SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is'available within.200 feet.) i Septic Tank: Distance from"nearest well_________________Distance'from 'foundation--_-.___.--_._.___ aferia4-------------------- ----------------------------- EM gT) -__"-"._--"-.__..-._EMgT) t4 C— No. of compartments'. Size---------- } ------------L-u*id dep `n Capacity Disposal Field: Distance from nearest well___!:._.- __-Distance from foundation----45__-___.---.Distance to nearest lot line`_----'__ f F_X�TI 11 G Number of lines_________ __________________°-"-Length of each line-------7-.�---..._ Width of trench _-___ s ji,or �------------- , - &D DL Type of filter material_: QC __�___Depth of filter material_�____36_____..To#al length________._7�--_--"--------------- N Seepage Pit: Distance to nearest well___r_-----_--------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits-- -::---Lining-material-----------------------Size: Diameter_,.._-,_„A.--------- Depth---------------------------_----- 6 Cesspool: Distance from nearest well-----------------Distance from foundafion____----------------Lining material---------___-____-_.---_"__-__._-_-_-. ❑ Size: Diameter----------- ---------------------Depth-------------------------,------ -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well i__ _.___-__----.___.__"-- ,--_--.:_Distance from nearest building------------------------------------------ ❑ Distan to nearest lot line------- -------------------------------------------- ------------------------------_----------------------------------------------------- t Remodeling and/or repairing ( escri e _._.._-BRom____619_F1R6�"-___�V�DRTt.U�S�_.____�___NO_----OTHFka) .Ac JIV TR --------�,> R l- AyA_[L_49_f3_�-=�------�1�N-D-----i5-------J=KT_PN.D>;�,LZ-- - -°-----CA-�R�7_/Y ----- c�_7�-._5 — ------wt_k�---- ----QNB t LT _R !4T.1`�� FO.9-----Fcr?c� N-�P: ------------_T-t_K q------------------------------------------------------------------------------------------ ------------------------------ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S Haws, and rules an egulations of the San Joaquin Local Health District. ` (Signed)----- -- --- ------------------- -- -----------!----- -------------- -------- ---------------- --------(Owner and/or Contractor) By:-------------------------------------------------------- )-1 -_Q----------------------------------------------------------(Title)---------------------- -------------------- - - -------- ----- (Plot pian, 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---- - ---- ----------------- ---------------------------------------- DATE------ - REVIEWED BY--------------------------- ---- ---------- --------------- ------ -- ------ DATE------------------- - --------------------------------------- BUILDING PERMIT ISSUED------------- -------- •----------------------------------------------------------------------------- DATE------ -------------------- - ----------------------- Alterations and/or recommendations-----------------------------------------------------------------------------------------------•-•I------I----------------------------------------------------- __ -----------------------.-_-"--__"._".--._--...-----------"___-"--""-"_."_________._" i _______.-.__._.______._..-____.._..____..--______"__.-------------------------- • --------------------- ..__.,.____________________._4 -------------------------------------------------------- - __ _ ________________ _____ _ "___" ----------------------------------------_------_---._-------.-----------------...-.-.-------------------------------- FINAL INSPEC Date----------- ------—----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-•63 C.p.CD.