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F s FOR OFFICE USE: APPLICATION POR SANITATION PERMIT Permit No. ... ..........;... f ----------- -------------------------------- y . . -- ----- ------ -------- t (Complete in Duplicate) 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�defscribed. This fp 1' t' is made in compliance with County Ordinance No. 549. C_x3LCljt JOB ADDRESS ANPV D OCATIC) -N...- _F...... .. 1_A :_ t'l L-. ..QF }''' I Owners Name----------- E-— ---------- Address -------- lV Phone z, .1,53.0__......VIA-1--N-6-'- ----• --S - ----------------�-S` CPkaN----------------------- ------------------------- ------ Address-------•-• - - - -••--------' - Contractor's Narrie--/1_ ------ )�TM-C—__._1_M4K------ .1_ ----------------------- Phone------_-------__----------•-- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court •�-__ ❑ Motel ❑ Other [INumber of living units: -__ Number of bedrooms � Number of baths -_1_... Lot size .___. _._-__��-e---------------_------ Water Supply: Public system ❑ Community system ❑ Private"'�Depth To Water Table'357 it. P LT ��t 01 y-L 41.�'elavy Loi am Clay ❑ Adobe,)] Hardpan ❑ Character of soil to a depth of 3 feet: Sand Gravel Sand''Loani. - k Previous Application Made: (If yes,date--------------------} No eiNew Construction Yes o ❑ FHA/VA:'Yes E] No TYPE-'01=-1NSTALLATION-AND -SPECI; 1GATIONS: -- (No septic tank or cesspool permitted if public sewe is available within 200 fee+.) f I Septic T nk: Distance from nearest well____S�____D fiance from foundation-n—A9 ---..-- a#err I �-��f -•• • �� No, of compartments_.___'----.---..SizX. -_J-.---Liquid dep}h-___p {z ____.--Capacity...-- �"?. --.. Dispose ield: Distance from nearest well...R��FDis�tande from, oundation.....ID ----Dfistanee to nearest lot line�_�r_...__...._ Number of lines f------- - --- YO-0.,f, Vtilidth of trench �.... Type of filter mater`ial...Na-C l 1De�gh o`fffilter mlaterial_I j_�____.___.Total length------------119-Q____ ------____ Seepage Pit: Distance to nearest well________________�¢--Distance from foundation-------.........—Dist a;ce to nearest lot line-_-_.__.....___._ ❑ Number of pits--- 1-------------Lining material--•------------------.-Size: Diameter-------�---i--------,Depth-- •-•- Distance from nearest well.----------------Distance from foundation__._---_______ L rein rmaterial____-_..__ Cesspool. Dis ❑ I ( Li ui� P� }Y r 9 Distance from.,------ • ------------------ -------Depth_------------------•------------ -- ----------- dl�Ca au �-------------------- els. Size: Diameter) I ----iDistanfe from nearest buildirit " Privy: �.. nearest well------------------ -------------- ------- - �9----------i;)---�----••--------•--------� ❑ �.f I, .� Remodelingand/or Drepairing tce Lodes i (describe):--- IN -------------- T �� 3r ... e&I,_ of �_J,.-e - p�_r!. ret_ > _ �q;�p---- - !`ccE_tiPJAI__7#1S_ �5 I hereby certify t I prepa d this a lication and that the work will be done in a1coidance with San Joaquin County Tj ® ordinances, State la nd of the San do uin Local Health District. r r 3 ........ (Owner and/or Contractor) Si ned --- -------••--� ----- ;.r w- - .,rte ------ (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can 6e placed on reverse sides ti TSA �h�, FOR DEPARTMENT USE ONLY ' � Y !� APPLICATION ACCEPTED BY- DATE - - 1AWREVIEWEDBY--------------------------------I_ - ----------------------=----•- - DATE-------•----------------------•---------------------- BUILDING PERMIT ISSUED--_-_-- ------------- DATE. Alterations and/or recommendations:__ 1_ ---- �••i /1� �.. f/ -- -_---------------L-------------- W/9------��57-1_._l--�.1 T��------�o TZ, .------moo_.. Q�........9V-------�� ---------- :. --------- ----------------------- ---------•---------i-------•-----------------...---------------------------•-------------------- -------------------------•--------------------- __._.-:----' _. ------ s � � I FINAL INSPEC Date ----------- ----------------. F ....... r------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,Callfornio Tracy,California ES 9 REV15ED 8-59 2M 5-62 ATLAS