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rUlt OFFICE USE: r ---------------- ---------------- -- ---- ----------------- - ------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ------- ------------------------------ --------- ------ This Permit Expires I Year From Date Issued Date Issued -----3__/1A-� Application is hereby made to the San Joaquin Local Health District for a permit to construct and in f,% work eon de crbed. This application is made in co pliance with County Ordinance No. 549. - - '�3Z3 3'S r w�4�ff 5 ( JOB ADDRESS AND L ATIONAW_ ---l`- -�q----FR-a-aM&E------,"•-gip- ._1�a------.13R V�v sw{_cl�.__._.�.t Owner's Name--------INRs 17.------ 4DO F------- -------- ----------- -------- Phone Address------- Y - �� 1 '� M-T[`C -----------------------------------------------ontractor's Name_______._ _ _ sI ---- ----------------------------------------- Phone----- •--•--------- --• - Installation will serve: Res ce � - -----" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Number Other Number of livi Elf ng units: -!':Number of bedrooms r -- Number of baths ___ Lot size ______ Water Supply: Public system ❑ Community system ❑ Private �bepth to Water Table/ ft- i Character of soil to a depth of 3 feet: Sand ravel ❑� Sandy Loam ❑ Clay Loam E❑ Clay❑Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date--------------------I No J]�New Construction: Yes No 'v� .� ❑ [�F]'A/VA: Yes ❑ No E�jl TYPE OF INSTALLATION AND SPECIFICATIONS: (Ito- No_se tic _.P tank or cesspool permitted if public sewer is available within 200 feet. _ Septic Tank: Distance from nearestwell.------------ --Distance from foundation__-___.-_____-__._.Material _____________________.__.- F G No. of compartments "' h -•a Size - Liquid depth ---------Capacity---------------------- - Disposai Field- Distance from nearest well._ ------Distance from foundation---la--- -.--.Distance to nearest lot line_____) ��Tfl46 Number of lines_ __'_.:_�f`�" ""'""''_-_"""'"Len-'-'-=Length of each line-__. a-'__-_ - - � HDC7 zt I g it-------Width of trench---- E Type'-of filter material_=-Ro�IDepth of filter material____1_ __.. ` Y Total length_{ --- - - Seepage Pit: Distanc4folnealrest well_ - •_Distance from foundation_______________ _ - __ Distance to nearest lot line_________________ { . ❑ Number af',,pits_-- ----------------Lining material----------------- - Size: Diameter Depth_-. ----- Cesspool: Distance from nearest well_-________- Distance from foundation______-__.__:_-....Lining material_________________________. ❑ Size: Diameter f------------ ------------- Depth ------ -- -- - --------- Liquid Capacity------------------ gals. Privy: Distance from nearest well_,_-_--____ -----------------------------------Distance from nearest building ❑ Distance to nearest lot line____________________ Remodeling and/or repairing (describe):--------------------------------- --- ------------------------------------------------------- -------------------------•------ -------------------------------------- --------------------------•-------------•------------------------------------------------------------------------------------------- ---------- �} ----------------------- ------- ----- - i A't --------- - ----- •--•-- ----- 1 hereby certify that I have pre ared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws nd r e a regulatons of the San Joaquin Local Health District. (Si ned g , ._ --(Owner and/or Contractor) By: -------------------------=---------------------- -r!----------------(Title)--- --------------------I------ --- ----- `------ --..(Plot plan, showing size of lot, location of system in relation to wells, buildin s, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY / # APPLICATION ACCEPTED BY .R,P ------- ----- ----------- DATE--------- REVIEWED BY------------------------- -t�� ------------------------ - �---- ---- �------�--- �- DATE------�-�-- ----�------- --- BUILDING PERMIT iSSUED_----__-_.-_-. - --- -----------------•---- -- ----------------------- --------------------------------------------------------------- DATE_ Alterations and/or recommendations-------------------------------- - %A:- ---------- U+t 1ti F ---------------------------------------------------------------------------- -------------------------------- FINAL INSP -- Date- -------------3-- 2.7-66 ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.