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FOR"OFFICE USE: --------------- ------------ ------------------- ---- ------------ - --------- _-"----------- APPLICATION FOR SANITATION PERMIT ----Permit No. .ala.-?_5 -(Complete in Duplicate) f Application is hereby made to the.'San Joat peLoctal Hptres 1 Year From Date Issued Date" Issued __ -"z quiealfh District for a permit'to construct and install the work herein describe This application is made in compliance with County Ordinance No. 549. -- ' J ADDRESS AND LOCATION_' d,fc�(" /I3 kD"" '� , � (f - ---------------------- --- /_�—------ ! Owner s Name- R W �_.�-----•--- - �"3a - -------- Phone--------------------------------- Address_ ' " r,S r- Contractor's Name" ___.---- F F I r" E -- ----------- Phone=---' ------ Irtstallation will.serve:, 'Residence #Apartment House E] Commercial E-] TrailerCourt'. ❑ Motel ❑ Other F-1l Number, of living units:.-2- N'um' ber of bedrooms _k Number of baths : Lot size ."-a�Z-"s?f ."-, "_•.3G f. SQ `f .V Water Supplyc•�Fublicbsystem ❑ Community system [] Private Depth to Water ;Table _1G ft: Character of soil +61a depth of 3 feet:x Sand B---Gravel ❑ Sandy1oaim ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ ' w Previous ApplicationMade: (If yes,date___--------_ - 1 No New Construction: Yesio ❑ FHA/VA: Yes ❑ No ❑may TYPE OF INSTALLATION AND SPECIFICATIONSc (No septic tank.or cesspool permitted if public sewer is avatlab�e w.fF; 20 Se tic nk: •. ° Distance from nearest well 3°d Distance from foundation__/P_"""- t'_,Matariaf_"- n p' No. `of cam artments__'� '"Size " _: :5 - """'w. -- ..-� p •�, - Liquiddeptli `� .--------------- Capacity.- G Disposal Field: Dis#ante {rom nearest�yrelL � bistance from foundation--- 'Distance to nearest-lot line_ "�'""••- ...1 «, { Number of lines------------------- -- Length of each " line---:Z5 --------'.......Width of trench-_kfType of filter material. ---------- ' �.- .,� -_--------_ -" --- Dpth. of flter_mat _-ft_------Totayl r length- tion ""__Seepage Pit: Darn+crest well �.-._____Distance from founda / _-."- Distance to nearest lot line�'� Numbeof p --------------Lining , material- -Q.C� ---Size: Diameter �__X�57_Depfh`- -- -" V7 Cesspool: Distance from nearest well-----,--- Ynaterial------Distance from foundation ._ """"" -"�----Lining ---------- w i ❑ 1 x Si#e: Diameter -Depth ------------------------°��-----Liquid Capacity-.-_-�_ -------- gal! Privy: Distance.from nearest well----- ----. ----------------_.-Distance from:nearest-bui)din s 4 _ Distance to neareslot l -------------------- -+ t: line _ --------------------------------------- ' Remodelingand/or r" airin describe P I / p g ( )�---��-- -F--�3M_""_"�At-�,�:D-=---�•�2A�A" -•:�"�R1I�.---1�___�:�?cf-t.---IN�T.�c�,ED� -----------------------------;---------------`------------ --- I hereby certify that I have prepared this application and that the work will be dcne'in.accordance with San Joaquin County' ordinances, State laws, and rules an regulations of the San Joaquin ocal Health Di"Strict: S. ; (Signed) C l - Tttle or] --------------------- -------- (Pl ot plan, sowing size of-lot, location o system in relafion to wells, buildings, etc., can be placed on reverse si e- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED°'BY- BUILDING PERMIT ISSUED-------- --•- - - ------------------------ -- DATE-.- = REVIEWED BY---_"---- ----------"""-- ""-,- _ �.. �. ------ -- v ::= ,: T -=-------- ------------- -------------- -------- - _ - t 1 �� ------------------------------------- A --------- Alterations and/or recommendations LL j• - - sl rF#��+F."._La`s-------Q--------- ------ ----- ' �� uilR �IP . �`ntQ - �" �."�"fel-nl -�._"SER - -^!-1 = �....._-- : r -- - -g Qn�_not Nr1. ". ..".. .ac; _r�"nl - -- c=4.._." -.---VV 4_7F�.----A-�6 a—:5 --- --- -•- �?: T------- '-.'---.A i�I.1 R: s. ------- ' •�E 1 FINAL INSPECTI - --- --- - -------- - -------- = Date. SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazelton Ave. 300 west Oak Street 124 Sycamore Street :.� 205 West 9Th Street Stockton,Cali}ornia Lodi,California Manteca,California Tracy,California €5 9 REVISED B-54 3M 3-'63 F.P.CD.