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-,-,rOR OFFICE USE: ------------------------------------- -------------------- --- ----- ------- ------------------- -- ------------ APPLICATION OR SANITATION PERMIT Permit No. ^/__745 ---------------------------------------------------- -- .(Comp:te in Duplicate) I in ---------------------------------------------;-------------- This Permit Expires 1 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. J# C 1)F 4. JOB Al !�D_'LOCATION LOCATION---------•-- -----&I - -------- 7 - -----------------------------------------------------R ---------- Owner's Name--------- ----------------- ---------- ----------------------------- Phone-----------------------•------------ Address_...... R J�---------------- -------------------------------------------------------------------------- --------------- --------------------- ----------- ----- --------------- - Phone----Contractor's Name------ ow ----------- ------- -------- -..,Pho ___--------------------------- 1110 Installation will serve: ,Residenca_o Apartment House ❑ Commercial� E] Trailer Court E] Motel Other El Number of living units: 6--- Numberof,.bedroqms 57�lumber o baths size Water Supply: Public system El Community sy 'em E]*O�PrivateNumber to Water Table ft. Character of soil to a depth of 3 feet: Sand Community 01 Sandy Loa'm L] Clay Loam [] Clay [j Adobe[j Hardpan ❑ Previous Application Made: (If yes,date-------_-----------) No New C'onstrucfion: Yes 2�No E] FHA/VA: Yes E] No TYPE,,OF INSTALLATION AND SPECIFICATION!L ' (No septic tank-or cesspool permi4ed rEpublic-seweras available within 200 feet. Se'p' tic Tank, Distance from neartsf well---------------tDistance from foundation------------------- Material-_-.__-__._.------------------------------------ exm;;0�4&- No. of compartme4s-------------------------!_SizA-------------------------------Liquid depth-------------------- -----Capacity_.--------------------- Disposal apacity----------------------- Dispo'sal F t I /,o .ield:,.;k f f idafion -_ -Di4ance,from nearest well__.- __.Distance from out -- -------------*-.Distance to nearest l9t line---- ..each of trend Number umger 6f lines.- --------I Length of n - %Ki-, / it si -70 ZTTyp6!.,of filter material-_,--16 !Cr Depth of filter material--------- -------- -----zt------1>-------- Total length------ Seepage'Pit: Dis'tance to nearest well---------------- ---!-Distance from foundation----!L--------------Distance to nearest lot line----------------- Ae F1 Number of pits_____!---------------Lining material---__------------------Size: Wa'rm-, r--------- ---.Depth------------ ------------- Cesspool: Distance from riearesf well--------------- D:istalriceVfr�o—m'foundation----0-1- _._.._..Lining material..._....--------------------------- -- Size: Diameter_ f------L--------------------------f D,p4---t_ ------------------WIT*_--__Li uid Capacity--------------------------gals. I Privy- Distance from nearest well---------------I----------M----------I---I�Iffa"�'c�e'ltdrn nearest building---------------------------------- ------- Distance to nearest, .0 F1 lot line----------------------------------------------------------------J A---11_1: Remodeling and/or repairing (describe):------------------ ------ -------I------------- --_----------------------1-1_-------------- --------------------------------------------------------- ----------------------------------------------------------I------ ----------------------------- ------------------------------------------ ------------------------- ----------------- - - --------------------------------------------------------I---------I--------------------- 0-------- ------- --------------------------------1-1--i--------------f------------------------------------------------------------ Co ------------ -------------------------------------------------------------------------------------------------------------------------------------W------------------------------- -------------------- I hereby certify that I have prepared this application and that-the work will be sone in accordance with San Joaquin County ordinances, State I s, an rules and r,eq i ns,of the, San"Jo uin'Local Health dj-itrict. A ' (Signed)--_-- Signed)-- - ---------- ------------------------------------------------------- -- ------------------------------- ----------------------(Owner. and/or Contractor) 9 -------------------------------------------------------------- - ---------- - -------------------- ----- ------ ---------V) : 6f,sysferp.in,relaiion to wells, buildings, efc"7 n_97placed on reverse side). (Plot plan. showing size' of,lot, location.1ca FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B-Y-- Tl?=Q`-------------------------- ------------------------------------------ REVIEWEDBY - 4 ------------ -i------------------------------------------- DATE------------------------------------------------------------- -B-UI'LD]NGi ,PERM" - -- — %-*---3--D--A---T---C-- Alterafiors'inWor ----k-----------I-L---------------------------------------------w-------- -o-A ------------------------------------------------------------------------------------------------- ---------- -- ----------- --- --------- -----------------------------------I----------------------------------- -------------------------------------------------------------------- ------- ---------------------------------------------------------------------------------- -------------------------------------------------------------- ------------------------------------------------- ---- - ------------ - -------------------------- ------------------------------------------------------------------------- ---------------- ------- ------------------------ -- ---- - --------------- --------------- ------ -------- ----- ------- -------------------------------- ------------ - FINAL INSPE ----- ----- - ---------------------------- C Date.......... -7-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton,Ave. 300 West Oak Street 124 Sycarn6re Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California rS 9 REVISED 8-59 3M 3-P63 r.p.co.