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�--FOR•Ol FICE USE: " _!�z -----------------=------------------------------------ �J ' APPLICATION FOR SANITATION- PERMIT Permit No. ...�_.[_.._'�..� --------------------------- -------- ---- (Complete in Duplicate) 1 . -� _ Date Issued ____. ..�___ __i✓r t------------------ ___ This Permit Ex ires.1 Year From Date Issued Application is hereby made to the Sen Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance.with County Ordinance No. 549. � - I JOB ADDRESS AND LOCATION [�� _IV1LIv # ----------------- 1rIA-WT�C.Pt-------------------------------•- �i - , Owner's Name - g - �= _- " [Jp�-�l -rte r - ----------- f. Phone - �2 S `FR ----=------ I�13NT LR-----------= Address-..--------- t 1t Contractor's Name...... IN-(V .: Phone t. Installation will serve: Residence Apartment E] Commercial ❑ Trailer Court ❑ Motel El Other E]-/OQ X lPq Number of,liv.ing. - units. __ .____,Number,of bedrooms. Number of baths,.4 Lot size Water Supply: Public;system ❑ Community;system ❑ Private Dept hfo`Water{T'ab1'e ; ft. Character of soil y to a depth of 3 feet! Sand Gravel ❑ Sandy Loam E] Clay Loam [IClay'❑ Adobe -] Hardpan F-1Previous Application Made: {if es,date- _____ ..,_.._-_-} No,®�New Construction: Yes �No ❑ FHA/VA: Yes E] No,3— � :.1 . � TYPE OF INSTALLATION ( AND.SPECIFICATIONS: - No fa- kcesspool P�tst fpubltc sewer ii av_aable,wthin'200__feet._ Distancefromoundation _�"- p `__Materia'_____ .�- -6._--X-_ __-__-_-_�--_ - ___�____ ______Dsancefron,neareel — Se tic k } : --' Liquid depth -------- -Ca acity.... . p ' ts -- - Size-- __ •- --- ------ --------�iT 'IryPj Distance to nearest lot line__Disposal Field: Distance from neaest'wellr_fl-----_.Distance from foundation_____/0_ l-.__ _ 13 1 1. � Width 'of trench---_kWIIVG Number of lines_�__ �.K- ------___.Length of each line -"--- 4- Adm Type of filter material _ {C- z_Depth of filter material-_____ _- Total Ien th____- _-----__________ Seepage Pit: Distance to near Steil_____________________Distance from foundation--_____________"-.-Distance to nearest lot line--__-____-__--._ ❑ ( Number of pits.------- -"---- ._-Luning. material----- --------------Size: Diameter---------------- ----- Depth-------------------------------- �p Cesspool: Distance from neare�t wll, __Distance from foundation---------------------Lining material-------------------.--___---_______-_ 1 gals. El Diameter Depth< == Liquid Capacity -------------- ------------- 9 Privy: Disfance:from nearest-,well_-_-__-.--:_:_______________ ----- Distance,from 'nearest b ing_-________-______________._----------r--- - �------------------------------------------=•------------ --- _.------- -------------------------------------- - - 1 ` El Distance to nearest of ine________________ t Remodeling and/or repairing (describe): -----P4�5113ff�- �-'T- - Q-F------- ------C4.-_r-`�-------/-W•--•---- IIA ---------------------- --------------------------••---------- 23A-------J=t�_Tc.l.f� — == --------------i-------------------- `= r . hereby certify that I have prepared this application and tl To whom it may concern 5/20/64 ordinances, State laws, and rules and regulations of the San Joi { I1 IThis permit was entered in the records Si ned -"---------11 - ( 9 this date - after S found it i.n. Mr. Church's =tea ------------------------------------ - - - -------------------------------------_- y --- - " - - � , . office. (See notes attached to back to (Plot plan, showing size of lot, location of system ire relation to wj indicate that Tom sent in all copies). T FOR DEPARTM could only find white copy and in order to have the permit on record, gave it a. number APPLICATION'ACCEPTED BY_---__ - _. -- ------------------- and filed. BUILDING�PERw11T ISSUEQ-------------- • - -= REVIEWED BY--------------------------------- :-k---------- ------------ -------------------- - _. iL._-- . �. Alterations and/or recommendations:�_----"______� --------------------------- --------------------- ______-___------------------------------ - tel {i ----------------- --- ----------``, FINAL INSPECTI Date ------ * SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California C6 9 REvisco 13-59 3M 3-'63 F.P-CQ.