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FOR OFFICE USE: <br /> ---- .4�--- <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------- ------------- <br /> (Complete in Duplicate) ued .... <br /> Date Issued3 <br /> This Permit Expires 1 Year From Date Issued <br />.................. ------------------------------------ <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 compliance with County Ordinance No. 549. <br /> ................................................ <br /> `2 ----------- ------- -------- _!ap <br /> JOB ADDRESS AND,gOCATION------ -o... —------- Phone..............•--------I............ <br /> pxT --------- <br /> Owner's Name.......... ------i'" LATHROP........................­­....................................... <br /> Address-------------------- ....... +"`}-------------131.....-...-----......._ <br /> .......... .... <br /> Contractor's Name_------- ------------------------------------------------------ .............................................. Phone...Other_E]................ <br /> installation will serve: Residence ga- Apartment House 0 Commercial ❑El Trailer Court [I ' Motel 0 <br /> Lofi.size ..................... <br /> units: --I---- Number of bedir!ooms,*3 Nu�nber of baths <br /> Number-of living ft. <br /> I,/ ify -system 0 private [I Depth TO Water Table .!R� <br /> Water Supply: Public system W Commun1 rf% 1) Hardpan' 0 <br /> Gravel [I Sandy Loam gT Clay Loam D Clay C] Adobe I <br /> Character of soil.to a depth of 3 feet- Sand 64. Nt� <br /> 1 <br /> Previous Application Made: (if yes,date----------------- <br /> ) <br /> New.Construction:-Yes gr`N6 0 FHA/VA. Yes El <br /> ----------- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: !_k3 <br /> (N o-septic-ta nk-or,cesspool permitted-if--public-sewer-is-available-within <br /> ----•---------- - ------ <br /> Distance frorn- nearest well-.--..Distance from foundation--------------------Material-------•---- <br /> Septic Tank- ---—; .-�---------Capacity------------------------ <br /> ------- ---------Liquid clep*_--- <br /> F X gTj tq'& No. of compartments------------------------- Size <br /> Disposal Field: Distance from nearest wellAbOA JE..Distance from founclation_1 ........Distar�ce to nearest lot line—------------- <br /> each line-----2L...... -----Width of trench -------- <br /> ------- ------ <br /> 9 <br /> -----------/ --------------- Length If <br /> Fye)---- <br /> g�Tj Number of lines, it length- <br /> Type of filter material...)?_6 0 — <br /> t0 --;.�K�N I I Depth of filter material------/97"'-=--Totalf - to nearest lot line:..__._____.___._ <br /> Seepage Pit: Distance to nearest well-----------------------Distance fro,rn foundation...................Distance- . ---------------3------------Size: Diameter..................---...Depth <br /> Number pits. Lining inaterial--, I � <br /> 0 "". " from foundation--------------------Lining Lining material-------------------------------•--•- <br /> ----*----------- <br /> Distance from nearest well____}--.---- --Distance .........gals. <br /> Cesspool: -----------------Liquid Capacity------_------- <br /> ❑ <br /> Size: Diameter----------------------- ----Depth----------------------------------- <br /> IF----------------Distance from nearest building-------------------- --- <br /> N ----------- ------f------------- --- <br /> Privy. Distance from nearest well -------------------------------------- -------------- -- ------------- ----- <br /> 0 Distance to nearest lot line-_-........... ------- -------------- <br /> _TA <br /> Remodellng!,a!Dd/or repairing (describe):------010? -1 <br /> 11 Z S qPI> 17-1 0Nj ----------- -------------• ------- <br /> -Tff-C- -- ---------- <br /> ---------------I------------------------ <br /> _M rte.- ------ <br /> T <br /> -----------------------------------------------ic=iq---_----------- .......... ----------------- <br /> I- ------O.AjiFl-;__��_ _F---11---=----------------------rIRSC) <br /> --------------77--- 1�------------ be done in accordance with San Joaquin County <br /> I hereby certify that I have!prepared this application and tha#'fhe work will <br /> ordinances, State laws, and rules and regulations of the San ,Joaquin Local Health District. <br /> (Owner and/or Contractor) <br /> -----------------------------------------------------------------(Ow <br /> ----------------- -------------_trifle)---------- ------------------------------------ -------- <br /> By:------t------------------ ---------------- on rever-s- _d- __ <br /> (Plot plan, showing size of lot, location of system in relaflon to wells, buildings, efc., can <br /> be placed FOR DEPARTMENT USE ONLY <br /> DATE------ --------------- <br /> APPLICATION ACCEPTED BY-.--- ------------------------------------------------ -------------------------------- <br /> - <br /> REVIEWED BY--------------------•------- --------•------------------------- <br /> DATE-------------------------- <br /> ----------------------------------------- ------ DATE-------I-------------------------------­-----------I------- <br /> BUILDING PERMIT ISSUED------------------- ----•--------- -------------------------- ------------------------ <br /> Alterations and/or recommendations:---------------- ------------------------------------------------------ --------------------------­-------------- <br /> ------------------------------- --------------------------------------- --------I-------------------­--------- --------------------------------------------- <br /> -------------------------------------------------------- --------­--- ----------------------------------------------------------- <br /> ...................I----------------------jr---------------------- -------------------------------------------------------------------------------- ----------------------- .......... ........ ----------­------------ <br /> ------------------­----(---•----•-- --------------- <br /> -----------------------I-------- --------------------- ----- ------------ ----- -- -----6/7� ------------------------------------------------ ------------- <br /> -------- ---- ---- ------I---------------- <br /> ............................ ............. ---- ------------------.. .. ... ---- -------- -------------------- <br /> Date---------e--------- . ...... -------------- <br /> FINAL I N S P EC <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 124 sycamore street 205 West 9th Street <br /> 130 South American street 300 Well Oak Street Manteca,California Tracy,California <br /> Stockton,California, Lodi,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br />