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FORD / ' - - --- �� ` ' APPLICATION FOR SANITATION PERMIT Permit No. ��p|�� uoMx�� `--- Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for m permit to construct and install the work herein described. This || t| is madein |i with County JOB ADDRESS AND LOCATION --_------------------------------------------.---.---...--_-----_----' uwnor m Phone............. --°-- _' ------_---'_--'--_.---------.--______---_-'--'-'--' -----_------ Contractor's Name----------------- -_--.---_---_----.---.-------- Phone--.---.---'_----' |nstaUmtimnwill serve: Residence R'° Apur+montHouea [] Commercial [] Trailer Court [] Motel [] Other 0 Number ofliving units: -'/.. Number ofbedrooms '2 Nunnbo, of baths 'A-. Lot size -'*X. ...'---.--- Water Supply: Public system [] Community system C] Private 0 Depth.to Water Table /001t Character of nail to a depth of 3 feet: Sand [] Gravel [] Sandy Loam El Clay� L�mm rl {�oy [] Adobe rclpmo F7 ! Previous Application Made: (If yes, '~ - Construct ion �Y-' -N6 'FHA/VA.'Ye4_&-No [] TYPE OF INSTALLATION AND SPECIFICATIONS: , 1 ` ' | (No sepfic � or cesspool if public sewer is available within 200 Septic Tank: Distanc6 from nearest well Distance fromi f6undatio" n------4000p, a en e,, ov Disposal Field: ~~'~'^~ ^'~^' ^~~'`~ =' '"°''"a � 5r- Number of of each �� f�nch' Type of filter mo+or|or___'---_-. i ` of �|+or mo+�riuL-*��.�~--To�n| |��g+�-'w�.m�8�'°,-_.--.-.-. TN . - �� . Seepage Pit: Distance foundation __-.__'-Distuncofo' nearest lot line_--- ~~ Number ----- Size: Diameter-------------- .......Depth----___- C� Cssqzoo|. Distance from kre �wU Distance 6o fo cl Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------- Distance to-neares ._-__------Disfuncehznaa,os lot |ine'''_-'' - ___ � Remodeling and/or repairing ( _____.._--________ .--._---'-'-------'---.--.---'�--_....._--.--'----_-..------_----.-_-��_-.._.�-_--------_-----.-_---- .-_'--___'-__'_-_--_-'----'-----__.---__.______--'__.'-_-.'---.--`--'_____'__.'--'------ � --'--'-----''-''---------'----'---------'--'----'--'-'---------'''-------------' | hereby certify that | h*ve prepared this application and 'fha+ the work will be done in accordance with San Joaquin County o-n-_-_- State laws,_ _- rules_ regulations of the San ---l--n ----. . -_.. ~~-~. . ' . . (°ge°�' v00 ��°m"m� � By . (Plot plan, showing- --- of lot- location— of system~ in r ion to wells, buildings, etc., can be placed onreverse side). F6R,DEPARTMENT USE ONLY /\PPLCAT|bN ACCEPTED BY...- --------------------------------------------------------------------------'DATE-.---- REVIEWED ATE----REV|EVYED BY-------------------------------------------------------------------------------------------------------------------- DATE'-''--''_-..__-__.____._ 8U|UJ|NG PERMIT ISSUED--------------------------------------------------------------_-------------------------------------- DATE_-_----_---.--.- .-' AMerm�onwand/or rmcomnmendat�nu:--.----------------..-.--.......'-..------.---.--__----_-----_.----.-.. . � � __--_-'------_''-'-''-'''--'-'''-''''''''-''''-_.-'-_'-_-'------__--,_-.`-_.---_______ `` � _-__.---'''''--.-'-''__'---''-''--'''_-''-_'-__-''''-__''-_.'-__---''-'__---''''--.-__.----- --'---'-''-''---'--'—'''-''--''''''''''-''----'-----'''''--'--'........... ----------- '------------------------------------------- -----------------------------------------' ------------------------------------------------------ ---------- --------------------------------------------------------------------'----- ` � FINAL INSPECTION 8Y�� /� - --------------------------------- Date--- --------------------''--'--'--_- SAN JOAQU|N LOCAL HEALTH DISTRICT 130 South American Street vooWest Oak Street 124 S,ca=°riytwet � 20mWest 9th Street otoxmon,California u,a/'«a/p"rnia . ` ` m�"�w'California `"`.' r�"v'Caxfw�� ' ` "s ° REVISED 8-59 ^mw-*/ ATLAS � �� /~ � .