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FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT Permit No. .. ...��--- •�- ---------------------------- (C _p Date-Issued ...v ._•..-.--�^•-� omplete lets in Duplicate).,, -------------------------------------- --------------- This Permit Ex fres l Year From.Date Issued ------ p- ----- -- -- ----------------- '. � .y, b Y. f f 04,P plication is hereby made to the San With Countca0 deriatnceDlNoC 549.a p rmlt to construct nd install the work herei� �rdescribed. �y+ This application is made in compliance Y „I C•�"� 1 .- Pp a ' �i �1 111 ft O '• I�r1a ------------------------ --- JOB ADDRESS AND LOCATION Q ---•----••---- ----- -- Phone.__ ---_----------------- --- ....._ /*7AJr- ------------- _ • ,. Owner's Name------- ---- � •---•-- -•---•----••------••-----.. ------=-•-• ---•-- ------ - one --------------- Address---- - ------:-_-------- Ph s • l p '1' = f Contractor's Name_.--._._./ � .1p. Motel ❑ •'� ` Apartment House ❑ Commercial ❑ Trailer Court .0 r.. Installation.wtllserve: Residence ❑ .... .... .......... G� y r ` ---- Number Numberof living units: l- of bedrooms . Number:of baths .___,_.. Lot size --- ------- t '�' " ' 1 k th to Water Ta Water Water Supply; ,Pubic system ❑ Community system ❑ Private Dep Cla Adobe`s )Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ®!Cloy Loam ❑ y ❑ No g— Character Made: (if yes,date-"________________ Noe New Construction: Yes �N° ❑ FI-IA/VA`�Yes ❑ lA k Previous App + TYPE OF INSTALLATION AND SPECIFICATIONS: , 1 (No`septic tank or cesspool permitted if pubr sewer is evadable with+ 200 feet.) -—r ----4- ------ mo i Septic Tank: Distafice from nearest well _ -$Dize' rf'�Xaer �-*. qu'd depth__..-- _�-..- --• 00 --Capacity: .:' No. of cornpartmenfs--- ------------ j .. T Distesnce from foundation_.-- -=......Distance. to nears$#clot linesT .-•-•-•- . { ` p~posal F Distance from nearest.welL/040.1- Width of trench. - --------- ----- AA - W Number of lines_-.._> .----=----- -Length of each line__��----- �i ---Total length. , Depth,of filter material--"• -_-- / Type of filter maierial�, - F Al 1 _ Distance Seepage Pit`: Distance to Weare$ _e -------Distance fm fo nd5_-Size: stet-_-: f }o,pepths}to ins_'. --_--:---` Linin material._-- --._Q l Number of pits.- _ g --....._. =- Distance from nearest well .............Distance from foundation"_-._-_r_---__.___.Li Ing material.. _gals. Cesspool: Depth Liquid Capacity. r ❑ Size:;Diameter-------- -•-------------------- p - --•- - ---- r - --Distance from rearestbuildin39 `.�' r Privy: Distance from nearest well ---------------------------- Privy: ------------------------- ---= == ....... Distance to nearest lot line--------------------------------------------------- "-- » qq " 6 - {E ' Remodeling and/or repair'ng descri a :------"..__- ; t 164 �r_..- PG . i-llJ�' �/�&_14--------- ------•-------••-- ----------- --- .-- �d----------------------- v _ (� gain C B� I les and re ulations of the San Joaquin Local Health District. I hereby certify that 1 have.- re ared this application and that the w A wall be done in accordance;wi San oXll a ordinances, State laws, and ru , 9 tom. N� ----.-.-----•- yContractor]��'---------- d/° 1 , ------- (Signed)...------•-------•-=- = - -�� - - - --__ ----------------- ---------- By "_ ----- } t' i Title r' By .......................................... . ' (Plot Ian, showing size of lot, locattan °f "system n relati to wells, buildings, etc., can be placed on reverse tide).�� ;r�,•, '`. ',-OR DEPARTMENT USE ONLY DATE-------- 2 , '------ ..--•- 1 APPLICATION ACCEPTED BY DATE_: .-----•--------� t REVIEWED BY__--------------•------------ ,_----- f -------• E --------------- ---------------• DATE---.-------•--------------- ----- 1 .---.. BUILDINGPERMIT ISSUED-------------------- - ----' - ----- -------------•--••---•-•---"--...--•-...... k i ---------W-..------•-•• •------------ Alterations and/or recommendations:-- '__"k - --------------- ---- I ,--- ---•- _..---- ayf ------------- de ------------------------- 4 rlr� i. 1--, "".--"..--_------------ FINAL INSPECTION BY:- -" -__ Date------ � ..................."---.-"---'-- * SAN JOAQUIN LOCAL HEAL-TH DISTRICT Oak Stteel 134 Sycamore,Stnel 405 West 9th Street 300 West 130 South American Street • ,manteco,ealifornia Tracy,California Stockton,callfornia Lodi,CaliForT91;1 � , � 4 't✓1. � mow/ E6 9 REVISED 6.59 8M 6.61 ATLAS - n'