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FOR OFFICE USE: --------------------------------------------------------- -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .....1-42TA.-.7 ------------------- ----- --- ------------- -- --- -------- This Fs8,k.t, Lear Fror M- to Issued I Date Issued ---•-_-••-•-•- ----... --_.._.-- ..___.._____ .... .... Permit Expires I a ----- -- Application lis hereby made to the"San Joaquin Local Health District fpr."rFdit-to construct and install the work herein d6skribed. This applica�,.o.-n-is--m—ade-.tn.--corripli*r.icw-with-'Cza'n-ty—(Yrdin-& ce-"Ko-.wg9- 11 JOB ADDRESS AND LOCATI 1 "`-------/ 0-------A4.LYAIq ---_-----_----- Owner's Name_______________ __S.........MARYIN-------------------------------------------A------------------•- Phone------------- -------------_- 7-71 Address_________________ / ---------- ................................................................. ------------M-ANTE--c0q. .. Contractor's Name--•------- -- ... ------------- -- ----------------[................... Phone................................... Installation will serve- Residence Apartment House Ej Commercial C] Trailer Cort El Motel 0 Other 0 Number of living units: _11 Numllr of bedrooms 3--- Number of baths//IKK Lot �ize ........ ---—----------- Water Supply; Public system Ej ommunity S stem F] Private gl-IDepth ;o�_WKater Table /Y ft. Gravel C] Sandy Loam 0--'Clay Loa ❑ Clay E] Adobe[] Hardpan 0 Character of soil to a depth of 3 ,flet: Sand J�Fll M. rl Previous Application Made: (if yes date ...... Na [I New Construction: Yes © Na E] FHA/VA: Yes ❑Ej No ❑ ------- ---- —TYPE4-OF-INSTALLATION ANDAPECIFICATIONS: (No septic tank or cesspool!Permitted if public sewer is available within 200 feet.) Septi k: Distance from nearest well---54 01 -; e 'Tr*o`m-%undafion.____/ -------- Worn _ , I I' — , 0. dc-_- 115 -- 1-111 of compbrtments-------02 -- -- ---...Liquid dep h------ ----------------c6p No. --------- Disposal Field: st well-50 -rr"C",V ndation----IV— -- .Distance to nearest lot Distance from teare Qies.4ate Length 60-------- ....Width of frenchAAj.36_!"_. ------------- 15�xlwl C, NuMbqr of lin4----------/ ---------- of ne--------t �44 fifer:rnateria ------ -6.0----------------- 4- lip e 4.,;Qtt% ----------- Depth of filter aterial------191--- ----Total length-- ------ Seepage Pit: Distance to nearest well_____.--------------_.___________Distance from flundation--------------L_Distance to nearest lot fine_________________ El Number of pits!---------------------Lining material----------.___.--------Size; Diamete'r-----------------------Depth--------------------------------- Cesspool: Distance from, earest well-----------------Disfance from foundation_-_______-__ _____.Lining material------------------------------------- 0 Size: Diameter- ------------------------------------Depth-----------------------------------------------I----Liquid Capacity----------------------------gals. A rT r Privy- Distance from -a e. ------- --------------------------Distance from tearest building----------------------------------------- Distanceto nea sf lot line--------------------- ----------------------------------------------- ----------------------------------------------------- Remodelingand/o repairing (describe)---------- --------- ------ --------------------------------------------------------------------------------------------------.......................... X1------------ ------------------------------------------------------I------------------------------------------------------------------- --d ----------- -- -------- - ----------------------- - ---------- _1-----------------------------------------------------------------------j ------------------------------------------------------------------ 1. 1 AA=3 VV I I hereby certify that I have prepared this application ar J that the work will be donein accordance with San Joaquin County I ordinances, State &s, and rules:and regulations of the San Joaquin Local Health District. (Signed)---- ------------7- --------------(Owner and/or Contractorl-- ---ZCL_e�6' --------------------- - ---------------------------------- --- NOMMI-M, Sy:--------------- --------------------t------------------------------------------------------------------------------------------(Til i le)------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---=ARA2'------------------------------------------------------------------- IIATE--------- --------- "'ATE REVIEWEDBY----------------- ---_- --------------- --------------------------------------------------------------•--•-------------- 1) -------------------------------------------------------- BUILDI,-NG,J'-ERMI.T-ISSU.ED�.- .,—.-- ------ -------------- D AkT E-------------- ----- --- -=_1 I W I I T 1�__W--_;r---- ---------- Alterafi&Rs -a�nd7'oir-ec-o-m-m—enira,f-icins:----------------------- 10!0 - -----------�� 01 - --------------------------------------------------------------------- ------------------------I--- ------------------ --------;r---------------------------------------------------------------------- K-----------------------------ZRA�� 9 ------ ------------------------------ ------------- -----------K ---SA71�------------------------------ -----------------70--N-K 0' ---------------------------------- --------------------i ----------------------- ----------------------------------------------------------------*------------------------------------- 7 -2-------------------------------- ----- --- -------- ............ -- - --- - ------------------------------------------ ------------------- -------------- -------------- ........... Date_-------- -------------------- FINAL INSPECTIC) SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California I Lodi,California Manteca,California Tracy,California Es 9 RdsEd 8-59 2M,9-62 ATLAS