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------------- APPLICATON FOR SANITATION PERMIT permit No. V4\pi��- --------------------- (Complete in Duplicate) Dufm Issued ....................... Application made to the Sao Joaquin Local HauHh District for m permit to construct and install the work herein described.is made incompliance with County Ordinance No. 549. J[}8 ADDRESS AND LOCATION...]L %%�_z._8.t.Dckt oD_____..__..____________._._.._.__________ Owners Name------------------------^------------Mr2i�_ ._C��IT�D��.______ ---------_------------------------------- Phone.......II0---27l ��__ Address................................................ ------------------------------------- Contractor's ___.______._Contmcto/" Nome'_T_laF_-]}.AY_&-_7J][G ---B.°_T^,...GyQ�_%------------------------...................................... phone_.__II�._6��4�__ Installation will serve: Residence [Z Apartment House E] Commercial [] Trailer Court [] Motel [] Other El Number ofliving units: '1..- Number cfbedrooms ----2. Number ofbaths ..1.. Lot size _--�7�«...][-l25o....................... � Water Supply: Public system [@X Community system [-] Private 0 Depth to Wafer Table -- ft. Character of soil to m depth of 3 feet: Send [] Gravel [] Sandy Loom [] Clay Loam [] Clay [] Adobe XX Hardpan Fl Previous Application Made: (|fyes,date--------------------> No [] New Construction: Yes [] NoU* FHA/VA. Yes D No El TYPE OFINSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is mvmUmb|e within 200 feet.) Septic Tank: Distance from nearest well-----..Distance from foundation--------------------Material --_--------_-----. (Existing No. ofcompartments--------------------------Size---------------------------- 'Uqui66ePfh--------------------------Capacity.--..---.-- Disposal Field: Distancefrom nearest woL-]�0%19 Di -X __ nce frn 'foumJ t; ;N� Distance to nearest lot8« i G�. �o�� Number o9 |inuo--'��.-------.-Long�� of ��c� |inn-- +h pf +rmnch 2411 ---- & AID Tvoo of filter mohoriw ___Rk--Depth of filter material ..18.`-_-.Tota| len _''-__-' 0,K Seepage Rh Distance to neuny� weL-._.-'-D|�unce �om �wndut�n__.__-__Di� �ancotnno�,o^ �t |�e—'--'- `W [] Number ofpits----------------------Lining material -._------------Size: Diameter------------------------Depth.-_----__.-- � Cesspool' Distance from nearest well D�� foundation ��| ��aL � -'-- - '-- - .� '- est building--------------------------------- Distance to ''-'--- uisronxero nearest lot / ~ - - - - .. .-- - - - -- - --- - _- -- --- ----- - -- --- --- - --- --- --- - - -- --- -- -- -- - - - --- - --- --- - - - -_--- ,--'--_.---_-^-----__.''_------_''_-'__--_''_----_--__...__.--.__-_-_----_ . ....---__-.--' 7 as, anhave �� ord�m �+~+~ �~~ ' ru�m' ' � | � -'''-n,'i ~^^ ~~^ ~~~q°^' =°""r ` y� (Plot plan, showing size of lot, location of system in rel n to wells, buil ngs, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y-------------------------------------- -------------- ------------------------------------------- DAT2.-----_---------_---- ' REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE BUILDING PERMIT ISSUED......... DATE- Alterationmand/or ---------........ - --------------------- ---------------------------------------- -'------------------------------------------- '---------------------------------'----------------------- ---------- ...--------------------------------------------------------------------------- ------------------------------------------------------------ ----------------------------------------------- --'—' -------''-'-'''-_-'''-''-'''_-''''_-'-''-------_-.---''--''---'---''_-.-_''_-''-'-''''-'�' ---''------'------''-- '-_---'''''''''-'''-''--'-'''-'-''-'-- RNAL INSPECTION Date--------.. � SAN JOA9UIN LOCAL HEALTH DISTRICT ^ 130 South American Street xouWee Oak Siro~ 1z*Sycamore Street xwoWest 9th Street Stockton,California Lodi,California Manteca,California n*"v'mmnfo,"/w ' mpREVISED °'°. o= u'mATLAS �� "