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FOR OFFICE USE: ------ ------ ------ -------------------------------- APPLICATION i'R• SANITATION PERMIT. Permit.No. .. _!G7 (Complete,in,Duplicate) -- -� ttk7•=- - __._..__ Date Issued This Permit Expires 1 Year From Date Issued ,�•: .. Application is hereby made to the San Joaquin Local Healfh District for a permit to`�onstruct and install the,!Work-herein described Thispplication is made ' compliance with County Ordinance No. 549. �' .. �� / MOON, JOB ADDRESS AND L CATIODN�....-- ---- R ftr4---•----- W... R^t. �( � Qct n ------ ----------- -' C ------- f _ Owner's Name > lV_ �M—ARN R_- n--- =------------------------------ Phone- 61-9---75 Address__...._-.,.. _ 111AA- E- ------------------------------- ----------- Contractor's Name----------��-------------------•-=----------- ----- ---•• -------------------------------------------------------------�--`Phone------------•---......--•---------- h Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other..❑ ° Number of livingunits: _. ____ Number of bedrooms _ .- ._`_/�} ----_--_--_--- � �._ Number of baths,___I_-_ Lot size-.- - Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft. Y�I Character of sail to a depth of 3 feet: Sand eGravel ❑ Sandy Loam ❑ Clay Loam n ay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date__.________________) No New Construction: Yes No ❑ FHA/VA: Yes 2T'_"No ❑ TYPE OF INSTALLATION AND,SPECIFICATIONS: --.^- 'p � h 7 I___L.[� _ - lJisfan a ro le-within 200 feet.)—/- P eet. -^ Nose tic-tank or-cess bol permitted if-public-s wer-is avails ) /- - T k:�� Dista'ncetfrom neaiest_w `�` m foundation _ �� Se Ic; M enal COW R�`� ---- � A,,. Z No. of compartment - _-- Size__ _� �__Li uid depth- _ . _capacity-/&"00___- ... _..._ .. q p. v, r ._Pisposal Field: Distance from nearest weft Distance frorim:.fo!nda#' __ __ _ Distance to nearest lot line f Number of lines______ _------------Length of each line__ '._Width of'trench "'_____________ rf ..... si -�. �p Type of filter material_. K_.:Depth of filter material� .r _-Tota€ lengthl_____ ____________ v Distance to nearest 'Well------t49____ -1.O_-=_-_:Distance to.nearest lot Line-_:_ �~ f Number of Its----- n ------ > - �i' p ------.___-. Lenin material-_- �C<�4.Size: Y k: ___Distance .tom foundatio -- 9 � - -- - - ; .Diamete - ---- -=- -------== Depth__ _ -- IEA k rr611,.1 J Cesspool: Distance from nearest well-------------- from foundation__.__..____�. inng�material--____._.____._____________R�� El Size: Diameter----------------- --------------------De th------I------------------------------ . Li uid Ca acitgals.rD i Privy: Distance from nearest well----------------------------------!.-------------Distance from nearest buiHin ___._.____._. I ❑ Disfance to nearest lot line-------------------------------- Y Remodeling and/or repairing (describe):------ - ................................... ---------- ------. -- -------------------------------------------------•--------------- -------------------------------•-------• j -------------------------------------------------•---------•-------------------------------------------------------------------------------------------------- -- --------------------------I------------------------------------- ---------------------•-----•------------------------------------- --------•----=----------------------------------------------------------------•-------------------------------------------------------.------------------- ---------------------------------------------=----------------- _--- -----------------------------------------------------------------•----------------------------------------------------------------------------- sTl hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances�Sffaffe, and rules and regulations of the San Joaquin Local Health District. SId -- ------------- ------------------------------------- --------- �9 --,�;�•--- ne ) [Owner and/or Contractor) VV _ter_- - - —..-_ --4 L. - .. [Title)------------------------------------- _ --_•---------- ------ -----------------�=------=•------=----�,- - -- ------- ---------•----------•--- -- -----.-- ----------- --• - (Plot plan, showing size of lot, locationW system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- _ F ----- ------------------------------------------------------------ DATE---- REVIEWEDBY--------------------------- -----------=--------------------------- .... -`DATE-------- -------'-------'----------- BUILDING,.PERM..IT-I$SU.ED------------------------------------------- ------ -_---:_-------------- ----------------------- DATE-------------------------------------------------- --------- Alterafions and/6Friecommendatibnsc - --------------------------------------` -----------------1-7----------- •-------------------- -------------- Z �/--------- / ----- -- 2t__ --- --- -- - ----- IEL -----6odt�`------ fj ------ = ---------------------- ------------- ----------- -- ------ - --- ------------- ------ ---- ----------_---------------------------------------------------------------------"------------------------------------ ------------------------------------ --- -- - - ---- FINAL INS TION B • ` Date f `�" =-------------------- _- ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.CO. 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