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FOR OFFICE USE. <br /> &, " •.�� OW <br /> 4-_ <br />.............. ------------- ----- ----- --------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------ --- - ------- ------------ -- (Complete in Duplicate)' Date Issued <br /> -------------------------------------- -------------- This Permit Expires I Year From Date Issued 2—f 9— 02-0-3-S <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This-application is made in complianceej4, <br /> ftwnty Ordinance No. 549. MA 1YIANITlE1 C19 <br /> 10 tJ <br /> JOB ADDRESS AND LOCATION.51.M_ <br /> -5496? 16 - <br /> Or-------- , V ------------- <br /> ----------------------------------- <br /> Owner's Name----- .... -e7__ ---------------------------­ Phone---------------------------------- <br /> I-------------------------------------------------------.........Address...------- ------&................ AyI PSR ...... <br /> -------------- Phone.................................... <br /> Contractor's Narn'JJA --- -------- -------------A------------- <br /> ?EST <br /> Installation will serve- A,7Nence ;Apartment House r! _E_]1_—Tra'iIer Court [3 Motel Ej Other 0-1111HOME—= <br /> serve-. <br /> Number of 16ving units- Number of bedrooms SNumber of baths; Lot size __A!�KfE---------------_--. <br /> ElkJE] .................. <br /> Water Supply: Public system aIC-ommunity system Private [-] Depth To-Ater Table .9-- ft. <br /> Character of sdir-to a depth of AeN Sand ��Gravel El Sandy Loam lay LoNkO Clay D Adobe ❑ <br /> i Hardpan C] <br /> Previous Applicatigh Made: {It yes,d fie- -----------------) No New C164 ruclion: Yes c, El FHA/VA-. Yes E!r�o [I <br /> TYPE OF INSTALLATION AND SPECIFIC IONS: <br /> 11200 feU.) <br /> (No septic dank or cesspool permitt + public sewer is Zailable withi <br /> I y Qi- <br /> Septic Xnk: Distance from nearest we I, --_ I Uistance f ror_pAunclaf ion--... - ----------- <br /> Y ff>o <br /> Yes <br /> I `.I� T <br /> _IC T <br /> L e . <br /> PUL <br /> ,,e,f we X N e. .....Mal <br /> UK X 57 Liquiddepth__-Z-',,-'/2—-------- <br /> No. of compartments-,_ etize3-:7.5.0K.,_1-------------- <br /> Dis Held: Distance from nearest well-ir VVW_E�_Distanc f n foundQ.ben'___./_0........Distance to nearest lotiline--------6_7------- <br /> Number of lines------13-----Z-----------Leg"-70fGAIR. .....MOW--------------Width of french.---- ----------------- Jf <br /> '�4* <br /> Type of filter mate riaj;?_0_CV',- _ pth of filter material-------/Y.........Total length------------------ ---qytz� <br /> See M7, CMsfance to Distance f'rofoundation----.k0-.......Distance to nearest lot Ili e---- <br /> • <br /> Number.of pi -#I? <br /> k� <br /> ------ --?ILAing materiaI4 -C,K-----Size: Dia meter- ---Depth------ - ----------- <br /> Cesspool: Distanceji!om nearest welf�oe-------------Di9tance from foundation--------------------Lining material--------------I---------------------- <br /> El Size: Dia`' --------------------------- Aepth-----------------------------------------------------Liquid Capacity------------ <br /> ---------------gals. <br /> fr 1 <br /> Privy: Dii fr nearest well --------------------------- -------Distance from nearest building------------------------------------------ <br /> Distance❑ <br /> merest --------------- ---------------------- <br /> f lot <br /> Remodeling and/or repairing (desNib -------:------------------------------------------------------------------------------------------------------------------------- ------ <br /> ------------ <br /> �m <br /> -----------------------------------------------------------------------------------------------------------------------------------------------------------------------I--------------- --­-­------------------------ <br /> -------------------------------------------------------------I--------------------------­­--------------------------------------------------------------------------------------------------------- -------4!- _---- <br /> ------------------------------------------------------------------------------------ ------ <br /> ------------------------------------------------------------------I......------•--•-•---------------------------- <br /> I - <br /> I hereby c ify that I have prepared this application and that the work will be done in accordance with San Joaq6in Co6nfy <br /> ordinances, S t la _s, and. rules and g ions sof the San Joaquin Local Health District. I .> <br /> k 3 <br /> - 1 antrGc or) <br /> (Signed)-__ - ----- _------------------------ ---- -- ------------ I ------ --- -------------------------------------------------------------_.___.Owner and/or t �5 <br /> 1A <br /> By:--------------------- ------------- ----------------------------- - ---------- ---------------------------------------------(Title)--------- ----------------- ......-------- <br /> (Plot plan, showing size of lot, ocation of system In relation to wells, buildings, etc., can be placed on reverse side). <br /> Ivy <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------ ------------------------------- ---------.............------ DATE___�Z=1�7,6_25---- ----------------------j <br /> REVIEWED BY--------•-----------------------_--------- •----------- ---•---._.. DATE----------------- ---------- <br /> BU I LDL-NgiP,EkY �ff ------ ......... AT_a <br /> E_ <br /> - <br /> - <br /> ---------------- ----------------- ------------------ -------------- - ------------ <br /> % <br /> ---- ------ <br /> — <br /> a.lot <br /> - -------- ---------------------- ----------------------------- ------­_­.........I­­ ----­--------------- .........- --- <br /> ---------­----------­-- -------- -----le--i------ . T.- ------------ <br /> --- --- ......A.. ------------­­----------------------------------------- --------------------------------------------------------------------------------------- <br /> - <br /> FINAL INSR .- ION --- ---- --- <br /> _ Date---------- . ..... --- - ----- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Syroet 124 Sycamore Street 205 West 91h Street <br /> St6citon,California lad],California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5.62 ATLAS <br />