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FOR OUICE USE. ------------------------------ ------ ------------------- ----- ---- -------------------------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. ..Z7&4-, ------------------- -----------:----------- (Complete in Duplicate) Date Issued ----------------- --------------------- This Permit Ex ire's I Year From Date Issued Application is hereby made to the S6n Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. A f *1 W is#DT—= L-A CF—E &I or M:7� 4— (::A L-01\1 JOB ADDRESS AND LOCATION----------- ILAI � / 74""y W rlv R.M_J-&.47----AOC -----------a-eh--------e��-----J//.�--------q-- - Owner's Name----\40.4-v------ -------------------------------------------------------------------- Phone__ 6;�, Y. y. Address---------------�Fl__,3...... --------------I------ --- ------------------------------------- ----------------------------------------------- ------7- /7-17- 6- 00----V_C _1V,04x1------ Phone--Y/-------------------------- Installation will serve: ResidenceApartment House E-] Commercial E] Trailer Court Ej Motel E] Other ❑ }%,k-3- Number of living units: Number of bedrooms Number of baths ---,?--Lot size-^....A7<?,eno> _---------------------- Water Supply: Public system ❑ Comimunity system E] Private Cf Depth to Water Table 6_0 ft. Character of soil fo W a4fli-bf-3 feet-Aand.-E] Hardpan E) Clay Loam el Sandy Loam C7,rovF] _. .la. y.,Ej_Adobe E] t gr Previous Application Made: (If yes,datel---------------_-.1"'No [j��New Construction: Yes 23-`qo Ej PHANA: Yes Ej No 1. TYPE OF INSTALLATION AND SPECIFICATIONS: (No s6ptic-M-nk Srcesspool' ermitted if public sewer is available within 200 feet.) Septi nk: Distance from nearest well---S.4------Distance from foundalion---------0----------Material---- Q._V_Lee,& ' No. of compartments_.___._._A-----------Size------------6_1XIC -- -------Liquid depth--- -- -- ---------Capacjty_/a_jQ_P------ Disposal Field: Distance" from nearest well----50......Distance from foundation.-.-/ �__Iebris'_P6ndb. to, nearest lot Number of lines---------- ----—---------------Lengfh of each Width of frellh---L_�991_111-----r- Type of,filter mate rial.R. ---Depth,of filter maferial----1/9-------'�-_Tofal lenrg'th---- -------- Seepa 2BI Pit.. Distance fo nearest. eIl----/4_0--------Distance from foundation-----ZO. ....Distance to nearest'lot line Number of pits____1W---?—_Lining material______1?rd_.C_e.Size: Diameter------d'Y_!7__"De,th_J-------------------------------- 0 Cesspool: -.Distance from nearest well___-__________-_Distance from foundatiq_n_ ...... - - - ;------------------------- ❑ Size: 'Diameter--------------------------------------Depth---- -----------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance,from nearest well---------------------------1------r_------ -------- -Distance from' nearest-building------------------------------------------ ❑ Distance to.nearest [of line----------------------------------------- /--- - V,�t Remodeling and/or'repairing (describe -1.Z ' -------------- µ------- -------- --------------------------------------- ------------------------------- -0---------- ----------, -------------- ?_�_ ____ ---------- - - ------------------------------------ ---:--------- -------- -P 0 4 1 4 -------------- ---------------------------------------------------------------------=-----------------------------t—e-41---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- -------------- ---------------------------------------------------------------------------------------- - -- --------- I hereby certify that I have prepared this applica on and thatfithe work will be done in accordance with San Joaquin Counfy ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. lef------ee ce le --- --- - ----------------------------------.(Owner and/or Contractor) (Signed - ----- - --- -- -----17- ------y �AIC By:--•----42Z a-4:2------ ----------------------------------------------------------------------------------(Title__(!.0 ._,P el_.,O/.�(___ ------------- (Plot plan, showing size ofdgf- location of system in relation to wells, "buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By- ____TTRI_d-------------------------:----- ---------------------------------------- DATE-------- REVIEWEDBY---------------------------------------------------------------------- ------------------------------------------------------- DATE BUILDING PERMIT ISSUED-,-----' -----------------------------------------------------------------------------------------------I DATE-------- Alterations and/or recommendations:------- ------ ------------------------------------------------------------------------------------------------I------------------------------------------------ ---------------------- ------------------------------------------------ --- --------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------- - --------------- ----------- - ----------------- ----•--- ----------- ----R--- ------ -- ------ ------ - --------- ---------------------------------------------------------- ------- ---------- .. - -- ------ FINAL INSPECT[ ---- Dafe-------------------- - 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 CS 9 REVISED S-r9 3M 3-'63 F.F.C13. 4