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FOR-OFFICI USE: <br /> . N FOR SANITATION PERMIT <br /> Permit Na ...- .r¢ <br />----------------- --- APPLICATIO (//� C,� <br /> - - - --------------------------------------------- .(Complete in Duplicate) Date Issued _C <br /> This Permit Ex ires 1 Year From Date Issued <br /> -------------------------------------------- --------- <br /> Issued <br /> NTF—c-A <br /> A plication is hereby made to the San Joaquin LocalOHealth aDiNoc 5for 49.a permit to construct and install the work herein describe H <br /> p <br /> Pp �# D e with County c <br /> This a lication is a in compliance _ r <br /> 4?0F"Slam- /_ / --------------- Phone_.-_.�'_T?------- <br /> JOB ADDRESS ND LOCATION__ �- . <br /> I. <br /> Owner's Name_ - <br /> -------------------- -----_------------------ <br /> -z� - _N- ----- <br /> -- <br /> Address------------�--•-- i Phone----------------------------------- <br /> I Name I�~ =----------------------------- ---------_-•----- -Tswf. Other <br /> Trader Cou'rt�❑ Motel ❑ ❑ *� <br /> Installation will serve: Residence � Apartment House ❑ Commercial ❑ ��� <br /> Number of living units:.- <br /> Number of bedrooms .3_. Number of boths _I_._, Lot size ------ R- <br /> Private Dep+h to Water Table .�-- <br /> Water Supply: Public.system ❑ Community system ❑ ❑ <br /> e obHardpan C] "1 <br /> Character of soil to a depth of 3 fest: Sand Gravel El Sandy Loam 08y Loam C3Clay ❑ Ad <br /> date------------ - -1 No <br /> Previous Application Made: (If yes, New,Construction: Yes �No E] FHA/VA: Yes ❑ No <br /> __,,,..... _ _=_ V, <br /> -.-: TYPEfOFINSTALLATION=-AND�SPEGIFICATIONS:-i— -�--­; � " <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Materia4______________________ <br /> t _ ----- <br /> Septic Tank: Distance from_nearest well-----------------Distance from foun atin Liquid de th__.-_ _-__._-------------Capacity______-__-____-___-___ <br /> !1`(G— No. of compartments----------------- - Siz . <br /> P. <br /> �l�'� �. <br /> t, , /O- "-"-_Distance to nearest lot line,' ""----.---- ' <br /> Disposal.Field: Disfiance from nearest well--/O0_ .Distance #rom foundation_______. -f IAA <br /> Len th of each line------ ---Width of trench------- _ ---- <br /> { -- Total length----------------•:__.� -------- <br /> material) 1) rJ N:e.of filter material___ -��--Depth of fil�tr -___._�9-�f <br />! i�Db• Typ •-_ Distance to nearest lot line_.________-__ - <br /> fPit: Distance to Heal <br /> resfi well_--___- Distance from foundation------------------- <br /> - Number of pits-------- -- T--Lining material--------' --------= ----Size: Diameter ------ Depth-------------•--------- ------ <br /> Seepage <br /> ❑ _ ...,�- <br /> 3 Distance from nearest well_________________Distance from foundation-__-____. -__---.Lining material__.--...._. --- -"" gals. <br /> Cesspool: � Liquid.,Capacity _ �----------9 <br /> ❑ --- :Depth.; :_ ,w:`:r»:.... . .r-�--Y <br /> Size: Diameter: -------------- <br /> _ <br /> " -- -" "-- Di`s+ance'from'.neaiesf'"i�ulld�nq <br /> Privy: <br /> Distance from%nearest well_.-,--------------- f ------ --- ._ ._.-_-- <br /> --------------- - -- <br /> Distance to nearest lot line_--___---------- <br /> --------------------------- <br /> --- <br /> ------------ d _ <br /> AJ <br /> ❑ des!rilae ,11 I R__. a ------�'----�- � '° <br /> Remodeling and/or repairing ( 7 �L ---"> '" <br /> ' --------- <br /> 1 -----f 5-----------l--4v-------- v0— ---------------•------------------------------------- <br /> ` <br /> 1 is application and thaum Local Health District. <br /> t the work will be done in accordance with S <br /> i hereby certify that.l have prepared tan Joaquin oun y <br /> h <br /> ordinances, State laws, and rules d regulation <br /> of the San Joag <br /> an <br /> and/or Contractor) <br /> ned --... <br /> ------- ---s- _ �- -----•, -- - .—,�;,.,,�,�;� ---�:- mow ,..',., .,.,�_r.,� <br /> wn <br /> �. (Si_9 )" -•. -'moi�"" --------- - ----- ------ <br /> -. - i <br /> -----------------•-------- -----------------i ---ion - -------- <br /> -------------. <br /> BY�- -------- ------ "-' � buildirsgs,-etc., can be placed on reverse side). <br /> l (Plot plan, showing size of lot, location of system in relation to,wells, <br /> 'FOR DEPARTMENT USE ONLY <br /> ------------------- DATE-------- .e---- 3Q--=63- <br /> APPLICATION ACCEPTED BY_��---�- -- -- ---------------- - ---------------------------- --- <br /> -- - - <br /> ---------- ------------- DATE.----------------------------------------------------------- <br /> -.-- -------------•---- <br /> REVIEWEDBY------------------------------ ------------ =`---�----aDATE------ ---------�._ <br /> BUILDINGaPERMIT'ISSUED__--- - == ,,. ----------------- <br /> _ ---------------------------- <br /> re' <br /> -- ---- <br /> Alterations /or recommendations: - .. r `- ` <br /> I -- ---_----- <br /> ------------ --------------------- <br /> ----- ---------------- <br /> --------- ---------- <br /> 6 <br /> . �. . <br /> Date----- ----- ------ --- - ------ --- - - - <br /> EINAL INSP N BrJ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 124 Sycamore Street 205 West 9th Street <br /> 1601 E.Hazelton Ave. 300 West Oak street Tracy,California <br /> I �Lodi,California � Manteca,California <br /> Stockton,California 7 �p_ <br /> E6 9 REVISED 13.59 3M 3-'63 F.P.CO. r <br />