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FOR OFFICE USE: --------------------------------------------------------- '------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .f.`��.� .. , ------------- -- (Complete in Duplicate) 5! Date Issued ... This Permit Expires 1 Year From Date issued ...... : Application is hereby made to the San 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. LaTHR0P , ."04 t 6-65 ,!�6 50 51 DF—. : f�3-3q v --Vg JOB ADDRESS AND LOCATION........J3.R-!_6Ci5-----8D------�n -_-UW_d�--CSR\[_ ------Ar_....f� ......--.---- qd Owner's Name--- _ nim -••-•-.6---A-L-1-�G_f1�IA-Q--------"" i •- ---- �- � ._ Q ...___... ..............------------------- Phone.................................... ;. , rl It Address------ `� '-••- =- - �� 1 -� rx_� -• --- = ----- ----- ---------------•--------:.... .......... Contractor's Name-------------0----•• �'�... _..-. - -- --•-•-•..... -• -•-------••----•-y Phone---........................ to Installation will serve. Residence j"Aparhment House ❑ Commercial ❑ j railer Court (D :Motel ❑ Other E] I" - I .._. Lot size c ... t Number of livingunits: _}____ Number of bedrooms ._ Number of baths Water Supply: Public system I❑ Community system Private ❑ Depth 1 Water Table /p ft. Character of soil to a depth of 3 feet: Sand /Gravel Sand Loam Clis Loam ❑ Clay ❑ Adobe❑ Hardpan [1 , P I� ❑ Y �Y Previous Application Made: (if yes,date_.______-___._._-_) No New Construe+ion; Yes �o ❑ FHA/VA: Yes ❑ No�i't TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic�tenk of cessptiool permitted if public sewer is available within 200 feet.) Septic ank: <0stance from nearest well___�.?�_-(__Distance from ou�ndat;on.---? ElNo. of compartments_.___-Z_-----------Size__ -X_ _ __ iquid depth__._.__ � `-____Capacity._..__ _----------- /0 �, rA �° Disposal Field: Distance from nearest well C�----Dista ce kom foundati`on.l.�. �.......Di arFlce }O nearest lo} Iine._______.__.y. . Number of lines----------- .----------------------Length of each line.... _:____ �yQ.�IVidth of trench.__ ____ ____ Type of filter material..._.�©__C-K_Depth of filter material*"�,� ..___-.--Total length------ ,� " * -9R,a. Seepage Pit: Distance to nearest well......................Distance from foundatit3°n__------------------Distance to nearest lot line____-___--_--_--_ ❑ Number of pits......................Lining material----------Size: Diameter------------------------Depth--------------------------------- Cesspool: --------------------------..--Cesspool: Distance from nearest well-----------------Distancte+frog unnd�tion__._._____________.Lining material------------------------------------- ^44El Size: Diameter.-----------•----- -- _--------------Depfh-----..0 ------------------•--------Liquid Capacity...............--------.:gals . Privy; Distance from nearest well--------------------------------------- _ Di fiance from nearest building---__.-_.______.._............_._-_._____. vow ❑ Distance to nearest lot line-----------•----------•-------------- -* -------------------------------------------------------------------------..-------------------` Remodeiin and or re airin describe :_-- :_�-_ �3._ .-to I //l[ Tf}4�- D_____-__ 6 X 7 �� _ g P g { I - --- -- ,7e -13........_.� ---------- `' `: ..3. -------- --------- A-5.---••- - 1 `- r 1/1f T`a A U `L r, ._ ------ ------- -----rva7....CDvj.:-:R�D...... .1-ra.._RQC.x----t3VF- -Q�AVa1pl._.5.1911----71-Hey W.aV I hereby certify that I have prepared this-application and'+hat the work will be done in accordance with San Joaquin County , ordinances, State laws,,and rules and regulations of tliY.San Joaquin Local Health District. Owner and or Contractor (Signed)-----... `;.................................. ( / ) s � - (Ti+Ie} :----�=------ �`=--_ --- r . (Plot plan, showingsixeof„lotjccation of system in relation to wells, bui 'ings, etc., can Wpl,,ed on averse side). FOR DEPARTMENT USE ONLY � J APPLICATION ACCEPTED BY---------- O --------------------•--------- DATE--------Tr” a--X6-3-------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE----------------------------------------------•------------ BUILDINGFPERMIT ISSU -- ----- -- ----- DATE------ Alterations and%or recommendations ... f-._ ._____� _._ .__ �?. ______ 1 1�11�!r`� /.�.i .. `� __/_N—s Tlff ......_ ��E&I------"7Htt�,lK/N�----Fdl_�.----WA-1�-----a-- -_ --f��7.0--'-----------A�S.Q_RO..... !��:----------- F.�Brri-- T-. ----tivs_Pr-CEf--= �nf��i�t �t -Tt N. o f5 ...............K--,----- © a �. M ......................................... ....•------- -- 1. _4� -------�_1........ ---------------------------------- ! -----------------------}------------ l � FINAL INSPECT[ BY: Dated Z ^ - -------------------- SAN JOAQUIN LOCAL-HEALTH DISTRICT ; 1 130 South American Street 300 Weal Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 8101 5-82 ATLAS �I