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DATE <br />_ DATE 1/ KL. <br />'..1. 1t20 -f <br />APPLICATION MR-SANITATION PERMIT Permit No. <br />(Complete in Duplicate) Date Issued //- 9- 5----ci <br />. This Permit Expires 1 Year From Date Issued <br /> I. <br />„pplication is hereby made to the San Joaquin Local Health District for a <br />permit to construct and install the work herein. described. <br />This application is made in compliance with W County Ordinance No. 549. „-Atriaz..A - . <br />. <br /> <br />JOB ADDRESS AN OCATIONA, <br /> <br /> Phone <br />Owner's Name_ .e.--42-•` e. <br />Address. fr2c.19 <br /> <br />Phone <br />Other 0 <br />FOR OFFICE USE: <br />Contractor's Name <br />Installation will serve: Residence 4 Aea r t m e n t House 0 CommerciaL Trailer Court 0 Motel 0 <br />Number of living units: J.... Number of bedrooms _2_ Number of baths .1. ..... Lot size <br />Wafer Supply: Supply: Public system 0 t CoMmunity system Private 0 Depth to Water Table . t ft. <br />Character of soil to a depth of 3 feet: Sand 0 Gravel Sandy Loam 1 Clay Loam 0 Clay 0 Adobe 0 Hardpan 0 <br />Previous Application Made: (If yes, date ' / I NI Y1, New Construction: Yes 4 No 0. FHA/VA: Yes p NoX,--- <br />TYPE OF INSTALLATION AND SPECIFICATIONS: 1. <br />pmi cesspool'ertt_.edTif public sew -5 avaik: Igwithin 200 feet.) <br />-..-, ,. .------ -, ,_ - -.4 -----• ..,--,-„, -..:,,,..:-..,..z..:-. <br />,/=-',-, <br />Sep •' Tank: Distance from /nearest well . . Mance, om f undatio • <br />No. of compartments -.-,. Size.../ X (0)4. iquid depth V---- Capacity_./ _2.4W <br />Disposal Field: Distance from neat well ----- DisWce fro foudatiorjr.6), . Distance to nearest lot Ii - fo, .. . <br />Number of lines ::-.5 LeAgth a eac-lline i Width of trench ....-R.,, <br />Typeiof filter material r i 7-2/-8-3k- Depth of filter material. i 4 Total length <br /> <br />$ a ....I .. .J.. 7 <br />Seepage Pit: Distance .rtc; nearestwell Distance from foundation Distance to nearest lot line <br />Number of pits Lining material Size: Diameter Depth <br />Cesspool: DiStance from nearest well Distance from foundation Lining material <br />Size:• Diameter Depth Liquid Capacity. gals. <br />Diita-rice •frt-Fritira.reit-we'lr-"---'-' bisi-ance . from nearest building .— ---1.--" ---•--- <br /> <br />1:: Distance to nearest lot line \ r, <br />Remo.deArt.., /or repairing j5lescribe): gee-14, .e‘‘....,,,, titarieele...ts,.1 <br />-. <br />42... ' <br />i <br />.4.1.3. - .a. ...elt--,.-4.+2-.t. e.o.,..f.-e...2 .. ,. <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br />(Signed) <br />By: -. <br />(Title) <br />"u'r(Proilla-rinliediviliglir larlatioriCifWit .rzricilt4ilitic-.11-5-Vvillirlialldin b-ellon ' <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY <br />REVIEWED BY <br />BUILDING PERMIT ISSUED <br />Alterations and/or recommendations: <br />(Owner and/or Contractor) <br />..... -•• <br /> DATE <br />FINAL INSPECTION <br />1601 E. Hamilton Ave. <br />Stockton, comprnia <br />Date -12 -50- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />Lodi, California - <br /> <br />Manteca, California Tracy, California <br />'t.'' '..;•1-:-.2t