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FOROFFICE USE: ------ ----------- -----'------------------------- N ------------------------.___..___._----------- ------ APPLICATION FOR SANITATION PERMIT Permit No. ............... .... ------------ ----------------------------------------- (Complete in Duplicate) v yam•--�-�-------`--Dade Issued -------------------------------------------------------- This Permit Expires 1 Year From-Dafe Issued �.- Application is hereby made to the San Joaquin Local Health Districtffor a permit to construct and install the work herein described. This application is made in co pliant with Cqunty Ordinance No:'549. A44NTE�C4 JOB ADDRESS ANJimm-4E OCATION- . - k......f-- OR TH �!_ � � M�' �A� �II�T�� OA(--•-1 Y•-.5 D g— .� Owner's Name---------- --------"-------FV(,=-rtf`•-•------------------------------------------------------------------- Phone................................... Address--------Kra-`/"_z y----..3.8 -- ---� � ...... . Contractor's Name...- .----•_.- Phone----------------------------------- Installation will serve: Residence Ap,.rtm��t House ❑ Commercial ❑ Trailer Court ❑ Mote! El Other ❑ Number of living units: -..... Number-40 bedrooms�. Number o baths �ot size _.._....#. _ __! } -I ........ Water Supply: Public system ❑ Comm ity system ❑ Private Number to Water Table _ f.ft. Character of soil to a depth of 3 feet: and 0 Grave! ❑ Sand Loam Clay Loam ❑ Clay 11Adobe❑ Hardpan ❑ Previous Applicatian Made: (If yes,date--------------------I No Rje,New Construction: Yes 0--"No ❑ FHA/VA: Yes ❑ No TYPE401F-INSTALLATION-AND-SPECIFICATIONS: (No septic tank or cesspool,�Permitted if public sewer is available within 200 feet.) Q , i Septic T Distance from nearest well__N!57Q------Distance from foundation...10........... mate,ial.----- :_ ----- ..... No. of compartments--------r.�------------Size- _X_ _ _ _Liquid depth.__- '___________Capacity..... ap_ �#94-- p C7_____Distance to nearest lot line__..r� at Disposal Fi Id: Distance from nearest weN____ �...Distance from found tion______ f 941-1, Number of.lines_____.____ '___._______Length of each n .Width�pf franch-____-_-_ .. � Type of fi{+er materiaL.. Qc+K_-___Depth of filter material______� _.___..._Ta#a! 1 Seepage Pit: Distance to neares# well______________________Distance from foundation____._:_.___._._....Distance to nearest lot line----------------- ❑ Number of pits------_-__--------- g ----.-------Size: Diameter.......:........� Depth--------------------------------- I'n Cesspool: Distance from nearest well Linin mDistanlce from foundation--------------------Linin mat Da ----------------------------------- Cl Size: Diameter--------------------------------------Depth--------------- ------ _�_.I_----Liquid Capacity--------....................gals. . Privy: Distance from nearest well_".__.____.__ ''FDistancetirom ;neares+ building____________________ -------------------- ❑ Distance to nearest lot line---------------------------------------- ��3 �1 Vf- ==- ------------------------------ Remodeling and/or repairing (describe):---------------------------------_ --------------------------------------------- ................................................--------------------------------------------------------------------------I---------- ---------------------------------------- .......... ----••------------- --•----•-••------------•--•--------•----•---------•-----------------------------••-----------•----------- ---------- ----••-----------•------------•------- ordinances, State laws, asld'�ave prepared this application and that the work will be done in accordance with San Joaquin County } I hereby certify that I� rules and regulation of the San Joaquin Local Health District. 1 � (Signed) - - (Owner and/or Contractor). R --------... --------- - ----------- Title -- ( ) ... (Plot an, showing size of I , to ion of system in relation to wells, buildings, etc., can be placed on reverise side). A FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ----------------------- ----------•------------------------------ DATE `-� Z� �.�2r�----^-e---------- z REVIEWED ___------------------------- ----------------------------------•-----------------------------------•----------------------- DATE----------------•-•------------ _ Alteretions and/or recommendations: ' ' C 4 -' DACE----•-- BUILDING PERIT=i55UED..` • _ I - --- - -------------------------- ------------------------------------------ -•--•-•-----.y------------- --- ' ----------- -- - - --------------- •------------------- ----------------------------------------- ---------- --- -- - --- E' -------•----------- ------------- ----------------------------------------- --------- -------�a-; .: f------ -------------------•-------------- - -- ---------------------- I ------------------------------------- . . amu, - �- ---------------------------------------------------------- _-•- ----R�-, - ----- - ----------------------- ------------------------------ ' l FINAL INSPECTIO .--- .f" :. .., *,.Date* ...'[/'•-71". ' SAN JOAQUIN LOCAL HEALTH ------------------------------------------ _3m, ISTRICT 130 South American Strout 300 Wort Oak Strout 124 Sycamore Street 205 West 91h Strout Stockton,California Locil,California Manteca,California Tracy,California E9 9 REVISED 5-59 FM 5-61 ATLAS