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FOR OFFtE US.?, 9__� - ------------------------------- ----------------------- - ERMIT Permit No. . ....... APPLICATION FOR SANITATION P -------------------------- Date'lssuad -----------I--------- --------- (Complete in Duplicate) I -Vol/ ----------- --------- ------------------------ --- ?-IELRitti!:��6r'From'Date Isibilid described. r and install the work herein descr' A A e Sanlioaquin Local Health District for a permit to consist C7_07 p ication is hereby made to thZo �?pplication;is made,i compliance -with County is Ordinance No 549, 7 _J613_ADDRESS AND LOCATION...------------ ' .--_T(4-P_ ----------- D--- �?O_ Owner's Name_____________ (J--------- --I__--- ------------- Phone----------------- ------------ - -- ------------------Address------------1'?Lrj5_:t -------- ----------Al ------------ -cl--------------------------------------- Phone-------------------------------- Contractor's Nam.____CARG-1-4�r�-------------------------- Motel [3 Other [3 Installation will serve, Residence [fl"'A'A'partment House ❑ Commercial 0 Trailer Court [I I T x, 5,Vz5r ------------- Number of living units: _!��Number of bedrooms Number of baths :�� Lot'size ----Ra-- -- ---------- -------------- Water Supply: Public system El Cmunity system El Private [Eybepth to Water Table -_6__ ft. depf h of 3 feet:: Sand 19 Gravel E] Sandy Loam [] Clay Loam [I Clay ❑ Adobe [] Hardpan Character of soil to a 0 11%r 3� ;<, /VA: Yes E] No Previous Application Made: (if yes,date'-.-------- No W/ New Construction: Yes'ET No E] FHA TYPE OF INSTALLATION AND SPECIFICATIONS: within 200 fe-et.'),�1 available wit F_ ff-_OU3; (No septic tank or cesspool permitted if public sewer is ava' N on---149 e Material__.4!?40^i0__ ------- Sepf;c Tank: Distance from nearest well---�.�___Distance from founclafi A------- do Ca acit �Q. No. of compartmen'is-----2----------------Size----�4.-X.10---Y_-.5--Liquid depth -- --- ------- --- -b--Wisfance to nearest lot Disposal Fi6ld: Distance from nearest well. afion -----Distance fro foung ---- ------- --- Number of lines ------Length oma"Vi ---Width of trench ........ -------- AP?--tr------Total length--------------------- ----- ----------- Type of filter material---- �---_D pth oftermaera--- '* I istance from foundation--------------!----.Distance to nearest lot line----------------- Seepage Pit: D;stance to nearest'well - ------- ---------------------i Lining material-----------------------Size: Diamete'r-----------------------Depth------------------------------- 17 11 Number of pits ----- in 111,-----------------Distance from foundation-------------[__.Linin*(�`mw�t8rial-------------------- Cesspool: Distance .from neo est we I -- I Liquid- pacitY--------------------- -- -gals. 11 SizeuMameter--- --------------- -Depth-------------- ------------- na -- V. I , -..P. - I ---------------- ---Distance from nearest building--------__-_--------- -------------- --------------- Privy: Distance from nearest well--------------------------- ......_1 is 01 ------------------------------------------------ El Distance to nearest line ------------- ----------__ I ----- ------------------------ 1. ---------------- Remodeling and/or repairing (describe}:- --- -- ------ -------t-----------------------------------------------------------------"-----'"------------------------------------& 1 0 111 1 ---__---------------------------------------------------------- -----------------------------------------------------------------1�-----------------�3--------------------------f--------- ------------ ----- ------------------------- ----------------------------------------------------- ------------- ----------------- ------------------------- 11 ----------------------------------------------------------------- II I. ,__.. I I------•---1---------------------------------------------------------------------------------------------- - ------------------------------------- ---------------------------------------- - ---------i-------------- I hereby certify that I have prepared,this applicMion and thaPthe work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of theISan Joaquin Local Health District: I -------------(Owner and/or Contractor) (Signed)------- -- ---------- 7 -------------------------W----------I -------- ------------------f------- 4— By:--------------------------------------- ------- ------ ------ -i------------------------------------ ------------- (Plot plan, showing size of lot, location a syste"m in.relation to wells, buildings, etc., can be!placed on reverse side). F_ & FOR DEPARTMENT USE ONLY ----- ----------------------- APPLICATION ACCEPTED BY----- ...... ........ .............. . DATE- . REVIEWEDBY------------------------------------ -- ! 1 --------- -- DATE----------- ----------------------------------------------- BUILDINGPERMIT ISSUED_______________________--- ------------- --------------------------- ---------------------------- DATE.--------------------------------------- -------------- ZI -----_---------------------------------------------------------- Alterations and/or recommendations:----!_--J-1--------------------- ----------------------- ------- f. 'It 111 ---------------- ------------------------ -------------------------- ------------------------------------- ------------------------------------------------- --------------------- -w 5-- 7 -------- -- ------------------------------------------------------------------------------------------------- -------------------------------------------------------1 �----- --, J----------------------------------------------------------------_ -------------------------------- ----------- ------------- ------------------------- - --------------------------------------- i -------- -- --- ------I--- -- --------------- - ----------------------------------------- --------------------- --------- ------------ ------- - ----- --------------- ...... ...... ----------------------------------- Date---------- TI�0 _ FINAL INSPEC� SAN jOAQUIN10-CAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi,California Manteca,Cal.ifornia Tracy,California ES 9 REVISED 9-S9 31A 3-'63 F.P.CD.