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FOR OFFICE USE: t ------------------ ------------- -------------- APPLICATION FOR SANITATION PERMIT Permit No. -..._-__----..... . , ------------------------------------ '. .. ' (Complete in Duplicate) `�/�Z� This Permit Expires 1 Year From Date Issued Date lssued �.. 1 Application is hereby made to the San Joaquin Local Health District for a p rrit o construct and install the work herein descrbed. This application is made in compliance with County Ordinance No. 549. 1023-0/fir, o) SOD ez CATION__ �� M �'T� JOB ADDRESS AND LO ��._AIRN..:��------ ► �.:_...._ _._1` � `-• .......--- Owner's-Name-------.6�.F3EFf-_........ -•--------••------_---•------- ------•------------------•---•-------.F..... Phone---------------------------------- CLIEW.I W-r --------•---------------------------------------------- Contractor's Name.ACA:--- -•- IC .-----------------••--------------- -•- Phone.. �+1 �F-�1 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ �:,._ Number of bedrooms __ � �--- ,rte -- ' �__ . Number f baths ____.__ Lot size ----- Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam �Cla'y ❑ Adobe❑ Hardpan Previous Application Made:r(If-yes,date__�-----------------) No New-Construction: Yes ETN6 Q FHA/VA-I.-Yes ❑ `No 2— TYPE OF INSTALLATION AND SPECIF=ICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �E i ``S r Septic ma �?�_k: Distance from nearest well__� ._--__Distance from foundation_____/]____........Material-- ..... (nJ � _ �7_._._Liquid depth------��--------------Capacity..... Q------ No. of compartments_____..___Size____. .aC__'_._X.- Disposal Field: Distance from nearest well %C�..._Distance from foundation..l.0...........Distance to nearest lot line____...__..... Number of�lines___.......J----------------------Length of each line..-----�Q��---f�---.Width of +ranch.------• -��----------••-• i Type of filter material._.R0. _Depth of filter-material.____1_ _______._Total��length....._.____lQ��-----------------•• Seepage Pit: �Di-srt-ance„to`t_ne-a_r.e..st well---------_____________Distance from foundation..._____._.._-_....Distance to nearest lot line_______________ 1 ininma Diameter Depth----------------- sL Ti Cesspool: Distance f{om-neare well__ � }ante from foundaton. -Linin material..----------•----------------------- ❑ Size: Diameter -------------Liquid Capacity-------------------------.. als. ` 1 _____Distance from nearest building --... Imo~ Privy: Distance from nearest well------------------------------------ - 9 �; ❑ i Distance to nearest lot line---------•---------- -------•-------'---•------------------•--...--------•------------------------...--i`'----------------------------------- ------------ Remodeling --------------•--------- ----- Remodeling and/or repairing (describe):-------------------------- I----------- .._... ----•------- - i ---•-• -----•-- ----- --------------------------------- -------i----------------------..._.------------•-------- -------------•-` .---. ----------..---------------- M-nil -------------------------------- -- --- 1 � -rules a d e nl - sof the San Joaquin work Health District.done ------------------------------------------ . - ----------------------------------- I ---------- --- hereb cern tat have Prepar this application and that the work will be done in accordance with Sen Joaquin County I ordinances, tat mss, � - -R- .�. -��"'----" x(Owner-and/or-C-ontractor --- 1, nT ,. (Signed- ------- -• --- ------- _--------------•----••--------------- ---- -- ---•----- ----- ----- - ---------••------------------------------------------ �,t ------------------------------------------------------------------------- Tifle)-------- F Plot Ian, showingYsize of-lot, location of s stem In relation tc,woils,!buildings, etc., can be placed o -- s -- Y' ( P ' • .)9 y on reverse side]. FOR DEPARTMENT USE ONLY i L-i F DATE_._. `�� --------------------- APPLICATION ACCEPTED BY___.__-_ � G.�4-N47Ar : REVIEWED BY ---------- ------DATE. BUILDING PERMIT ISSUED--------------------------------------------------------------- -----------j -1;; DATE,----= AFFerations and/or recommendations:-.----� T1�?_ _ -: ��---••_ -------------- �...---._ — s .-....r.r -r�.-..rns'_-- J_—......T-- .. ------------•---- ..------...1- -------- ------------------------------------------ ------- ------------------------- ----------------------- ------------------- FINAL INSPECTION BY:.._.S.-----D_.--.--- Date - S SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 0-59 2M 5-62 ATLAS