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FC)g ,aFfto USE; Permit No. ----------------- ---------- ------------ APPLICATION FOR SANITATION PERMIT ------------------------------------------- (Complete in Duplicated Date Issued ----7/ ------------------- ------------------------------------ This Permit A Expires I Year From Date Issued described. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein This application is made in compliancewithCounty-Ordinance;No?549. P,=u ay,T1 I ......................... LOCATION... OF 1�;c �9�----------- JOB ADDRESS AN ON. .7xP Phone. Owner's Name-------- -- ----- --------- 1***.-:z ('30 ...... W?, .. .. ..... ......... ... Address. ----------------- -----------r-�_ ------------ .........FT Frr:�. -Phone-- ... Contractor's Name..--- --------------- Other 0 Trailer Court [I Motel 0 Installation will serve:11�Residence g-"'Apartment House ❑[3 Col" rcia L size ------- ...... .......... Number of living bedroom of baths - _... Lot si ig units: .)----- Number of bedro Aww�MA IIISM I - � - V Water Tablet. temj�,"private-,Mj, Depth to Water Supply: public.s9s.tem.[D-Gomrnunity',sys V�jb.�k r. "it,_' 'R -i, I el C1 Er'6ay Loam 0 .Clay C] Adobe❑ Hardpan',n Character of soil to a depthlof 3.-fee+.-%�and1F_j: Grave sandy16am _,i"14 - -4o 0 FHA/VA: Yes [I No '�, .j - Yes ---------------I o,Qg,'�New Construction previous Application Ma (if yes,date TYPE OF INSTALLATION AND SPECIFICATIONS: s. e-r is available ithii, . 00 f et -+7- c a able W1 2 a septic a6k ot�cesspool Permitted 1? u6ri u— ion'7.W--------Materia ,!!!','D i sta:6E_e,f ro rn-.,1 1,-�n d:b i o�n . e" Septic yank: Distance from nearest well._4.......0- — aresf e 1.7AJ uid-de t0l-- --- ------------ --------- mpartmni -7 ... _-Nola: 0 mts-------�e------------ ce to nearest lot line----------------- r�Disposal .field: Distance from nearest wel I 61i stance from foundation.... .. ---------Distan -h Num*6r of lines........... . ----------------Length of each lineS ---Width of trench------------ Ty`p�`of filter mate riaL.R10-C'-K------Depth of filter material--- -------Total length--------- ------------- �iro m f(0) is ante ------------------- Seepa -- ------ ------ ---------------- ----------- nc rom ---------------building--------------------•----•---- Privy: --- Lining Liqu id . Number of pits - ----------------- Size: iameter-------------------_--Depth----------------- Nut ----------------------Lining material, El 1ining material----------- -------- • Jance from nearest well-----------------Distance from found n------------------ Cesspool: ------- a ......... nearest iz W: Diameter------.---------- r------Depth--------------- ---------------- - Liquid Capacity--------------------------gals. --------------------- S e El f C. fr m 's n ne buil Distance from nearest building-----_----_----------------------- Privy: Distance-from nearest well------------------------------ ----------- ................... ..................... -------------------------------------- ---- ---------- -------------- ------------------- -------------------------------- ------------- to nearest 16t line---------------_------- ' Remodeling and/or repairing (describe):__5-'.377/n ---------- --------- -------------- ---------------- --------------........-------- --------- --------------------- ------------------------------------------ ....... , — Zx �- __ -1.0/4 A ....... W I*J I—' A ------------------------- ---------�R VfMON r------------------W.1_47� ---- TF R accordance with San Joaquin County I hereby certify that I have prepared this application brid that the work will be done in a I tions of the San Joa'4uin Local Health District. Count R-,t i ordinances, State laws,_and rules and Wregul T; -----------------------------------I----------------(Owner and/or Contractor) tsignedX... 41,V A------ ------------------------------------- -------- -............ -------------------------------------------- ............................................................. ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 69 placed on reverse side). FOR DEPARTMENT USE ONLY 4pow-um -------------- ...... __Fi._R.�!o ------------� DATE------- ---nf- 11-_(4./ APPLICATION ACCEPTED BY-- --- --------------------------- 7 .......... REVIEWEDBY------------------------------------ ---------------------------------------------------------------------------I-------------- DATE------------------------------------------------- BUILDINGPERMIT ISSUED_-------------------------------------------- --------•---------••-------------------------------- DATE----------_-_----------- ---=-------------------•-------- ---------)�--------------------------------------------------------------------------- Alterations and or recornmenctaflons----------------------- &K --------- �0------------------------------------------------------------------- iF-=F LS...---___- �w- ---------- ------------------------z-rl rV 64jo b......5,4�?'TVXT>----7.PQ..WAFT ................... --------------A 077 FQN 05� ---- �GR -1-- ---------/V9 P P,a 6-ry_Ps 5--—------4A- <-K--- -- -0 = !7,4 V q _T----z�_ /9: T� ....... 0 f35---- --- - - -to SAYS _rHis. wa�K_ 7'lk-e PIRO C2 K Date-------------------------------------------------------------------------- FINALINSPECTION BY-------------------------------------------------------------- ---- M T_ L17r)crtpv( D8 SAN JOAQUIN LOCAL HEALTH DISTRICT 205 west 9th street 130 South American Street 300 West Oak Sires# 124 Sycamore Street Tracy,Co Stockton,California Lodi,California Manteca,California llfor nia EB As _60 ( I 5) REVISED 8-59 2M S-61-ATL 0 Fi I(\/ /5G\j Al F-_VNJ FOP- SlEamn