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FOR OIEFICE fJSE: ---- --------------------------------------------------- -----___------------------------------------------------- APPLICATION FOR 'SANITATION PERMIT Permit NojZxy .. ---- -- --- ------- -------------------- (Complete in,.Duplicate) 4. Issued Date su t LL --_ (p �_:S'rll2i __S_T-- -a- This Permit Ex rtes 7 Year From Date Issued T Application is hereby made to the San Joaquin local Healfh District for a permit to construct and install the work herein described. fThis application is made in ompliance'with County-Ordin nce-No.�549: ~-/-, -i� ` • -7 JOBI Ts " IL/V -51 a[� _; 11 l ADDRESS AN LOCATION-------- ,` � - ` � 6 /4 .. 5�� .Owner's Name- �RAx_F------ t�RAT� 0.3 _ 1 .. - ----is---��, - ... Phone -------------------------- ; Address--------------P Lr� ` _X__••`552...---T.R-� -----•------------ --- --- 1 ----•----------•-------- ------•------------------ --- !Contractor's Name--------------- `�`�n• -' Phone Installation will serve: Residence `Apartment House ❑ Commercial ❑ - Trailers ort ❑ Motel ❑ Other ❑ Number of living units: 41_.Number of bedrooms _3.. Number of baths __ _/Lot size "-__�7�__X.__I��____________________________ a Water Supply: Public system �ommuriity system ❑ Private ❑ Depth to Water:Table _ ._ ft. aCharacter of soil to a depth of 3 feet: Sand` GraveL❑ 5andyeLoam El_Loam E] Clay E] Adobe E] Hardpan ❑ Previous Application Made: (If y4,date.___.-_ _,.____� No 2N.6-w Const ction- Yes �o ❑ FHA/VA: Yes ❑ No } ,OF INSTALLATION AND_SP-_ECIFLCATIONS:. _�� -- -- _ No septic.tank or cesspool permitted ifublicewer availa6l 'ifhin 200 #eet, t' � r Septic T nk: u-,; Distance fromlnearest well_c __Distance fr foundation____ /0___._Material__REPI.•t w>--------------- No. of compartments------ ----Size-3--- -_ __X_5_7__Liquid deptO_ -/tl—-------Capacity------ -�-- ;Disposal Field:— Distance from nearest well-��.-.--_--.-_ from fount atibta-_. /_4��.____-Distance to nearest lot Ijpe____ ____ Number of lines------------ Distan _ `j " ---- 'Len of eac�i ane- w .; " rr Width of trench :-- c € T e of_Cfer material-___S-p_ C_KD fh of filter��'mate�rie l See a e Pit: -Type to nearest well_____________________ istance from foundation_��-1""___".Notal length________.__._""!" -- "Seepage p g Distance to nearest lot line__._...1'!R•� } ❑ -Number of pis-- -------------------Lining material-----------------------Size:.Di}meter---------- -----Depth--------------------------------- IV Cesspool: Distance from nearest well__.__:_ __�---Distance from foundation.--_f__1-_h'_-.-.Lining matErial_______________________________.-__. h j ❑ Size: Diameter =----=--------------- - -------Depth------------------------------- --- - ----�Uquicl Capacity----------------------------gals. ,. ----------------------- _�f Priv Distance frog mat lot linll ` pistance fro nearest building-- --------------------------------------- 0>r I. Y ---------------------- ----- ----- ❑ Distance to i � � ' :. fl .� ------ !Ren odeling and/or repairing {describe' �� -- - �_ -�� C� " VA g- Q z4-R- ------------------ `,R4o----------- --------- " ------ ----- -------- VA-- I ]----------------- -----• --------------------- ----- ----- ------------------------------------------------ .-.----------------------,-------------- - t- - - I hereby cel y-that I have prepared this ap'plicafion and:`thatsthe work will be doneNn accordance with San Joaquin County ;ordinances;.$ e aws, and rotes {nd r'.e 1 ins of t�SansJro,,qu al Health District. 1 Si ned ------�------ .--- ---------------------------- __..----- ----Owner'and or Contractor (Plot plan. showing size of,lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). , i t � ;.p FOR DEPARTMENT USE ONLY APPLICATION,ACCEPTED BY--- ------- k A-r---'`-`--------"----'-------=r------------------ DATE----- - -J 'REVIEWED BY -------------------------- -------------------------------- ------------------------------------------------------ DATE------------------------------------------------------------ 'BUILDING PERMIT ISSUED----------- T------------------------------- --------------------------=------------.------------- .DATE---------------------------------------------------------- -•-�' 'kat.. +' ' ' „Alterations and/or recommendations"L----------- -----.... -------- ----------- - --------:----------- -•--- I s I__________---------------------------------------------------.__._.._ _-----------------_------------------------------�_-_'�__._--_____.__._______.__._.___________________________._..--_:____________-_--------- ----------------._____._______.._-_._._...__._________-.- _ _____________----_ _ -.-_____-_._..__--___.__..________.__________._____-_-_.____._.__--_-_.____.___--_----- ------------ FINAL INSP Date--- ------- P / gl ~ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave,t , 300 West Oak Street _ 124 Sycamore Street 205 West 9th Street F Lodi, California Manteca,California Stockton,California .` ,1 Tracy,California - Il E5 9 REVISED.B-59 3.1M 3-'63 F.P. 1i a