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FOR OFFICE:kJSE: E: ----- ----------------------------------- ---11--------- ' ----------------------------.--------------------------- APPLICATION FOR SANITATION PERMIT Permit No. e,;; S� _ Co . . in Duplicate), Date issued-------- --------------- ` This Permit Exple ires 1Year-From Date Issued Application-is thereby made-to the San Joaquin Local Health Distr,ct-for a permit to construct and install the-work herein descried. This application is,'made,.irn.;complPane ,with County Ordinance No. 544. s JOB ADDRESS AND 1OCATI - __ 31 ti t � ,..rPs � �a Owner's Name 4I `Cdt _ f �_N :••--- ------- ------- - -! hone ` � D�� - ------- ---- -- -- - -- Address 7�L 0gTH I� - 1 Contractor's ------------------------ „"'Phone -~— -- - a Installation will _serve: .Residence ❑ Apartment House E]- Commercial railer Court ❑ Motel ❑ OtherFi Number of living units. _—__ Number of bedrooms4Y _-- Number of baths Lot size ___ ___-----42------- _ > - ------ i Water Supply: Public system •❑ CommuniysystemO-} Privae Qepth to Water Tables Character of soil,to a depth of 3 feet- Vsand Gravel-❑ Sand Loam f_Cla�Loam Cla _ Y 0 Y ❑ Y,❑ . Adobe 0 Hardpan ❑ Previous Application`,Made: (if yes,date----_ ---------- )-No RNew Construction:- Yes.E?�AJb-❑ FHA/VA:Yes ❑ No a-"' TYPE,OF-INSTALLATION_AND SPECIFICATIONS: _" -(No sepfic-tank7or-cesspool-permitted-if-public-seweris available within 200 Septic ank: Distance from ne est weH_,_`ti7 ______Distarice'from %nda ion---A__________ Material_�'�f�� - Of� TV4. of com artments_ �,, Li aid de th_-- e______.. Ca aci ®dam__ p ` --------- S,zej/ q f? 'city - p Disposal Field: D stance from nearest ell_ .......Distanc from ndation___.�iQ---___.__.Distance to nearest lot Length��f � Rr • ... Number; of lines____ _ ___ _ ---- c ,ne--_ ------------------ __ .Width of trench-------- Type of filter mater:al__:_ Q.-- Depth of filter material_------___ __ Total length___._ - --- f JI --- - t #r�- 1 . �7 SL page Pit: Distance to nearest well----------------------Dist4nce from foundation___"�_'�_______-Distance to neares#ilot Number oflits Linin mater,al-�-___...._____-____Sizei Diameter_______________________Depth______ i *� Cesspool: . . Distance from nearest well----------------- e from fouQ- a"tion___.________._--- Lining material -_____________ _ G El Size: Diamete'r--------------------------------------Dep ` -------------Liquid Capacity------- - ` r -9?ls. Q] i Privy: Distance from nearest well----------------------T___ _---------------___-t}istaince from nearest building 9 ---------- Distance --1--._. ❑ Distance to nearest lot line--------------- --- -- _ --- �- #- --------------------------- -------------------------- Remodeling and/or repairing fdescrif�e�: _. f�l� 'r � __--F—MNnY "`• • E �} 3- c �? Zt'1 = 1 �- I`11 r� iQ�5,f'r IRC r ---------- - ti -- L_--- L?--- � 7 -- r ©� -- f#c�i,r+IG-P$ - �-rly�� _+ n_�ofR1' _5 �-� pF BR�_.__ T._3�.d •� I hereby certify tha ve prepared fhi licetion acrd that the work will be done in accordance with San JoaquiW County ordinances, State and les d regulati s'o the San-Joaquin Local Health Dist ricf. PLV-5 R '?tT: i (Signe .r .------ " - - --------------�? Owner r racf r { an j- B"`-'�""r,r�,i.�"' c�.ee.y. ---- r � �.. �] - Ont O� Y• ---------4--- -------- --•-------- - - ------ ,--------- {Title - F-- *__� -� (Plot plan, showing size of I , location of system in relalit_ort;fo.wells, buildings, efc., can be placed on reverse side). . FOR DEP, RTMENT USE ONLY APPLICATION ACCEPTED BY t =1 � ------------------------------------------------ DATE------ _x _ REVIEWED BY-----------------.� ",-.----------------------.-- _ ------,,. DATE------ ------------------------ ` l .. - - --------------- - --------- ----------------- DATE _..- Alterations and/or recommendations: - _ -------•--------#------------ ---------------------------- --- ' A :r 1 # . --------------- 1 Xr�G---- d 160 ----- ------ --------------------------- ----------------- f " =--------•-----`------ ------------ --------------------------- : g FINAL INS N - � n Date ------- SAN -----SAN JOAQUIN LOCALHEALTHDISTRICT 1601 E.Hazelton Ave. 300'Obst Oak Street 124 Sycamore Street 205 West 9th Street y`r N CC Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-S9 3M 3-'63 F.P.OD.