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FOR OFFICE USE: IM APPLICATION FOR, SANITATION PERMIT Permit No. _ s� ... ------------------------------- --------------- i� (Complete in Duplicate) ' Date Issued ---�-. �� _.___.__---_.--_-.--__-- ._ I This Permit Expires I Year'From iDate Issued Application is hereby made'to the San Joaquin Local Health Dis`trictlfor a permit to construct and install the work herein described. This application is made in cyo�mpliance with County Ordinance o. 549. �O 3 - Z2O 2� r JOB ADDRESS AND LOC TION ---Cid-�? � "!d----'PLftC.r :__... �MAIS Owner's dam ' . IV I ----•--------------- Phone Addres ---- !Ka_ �` � ��... ---------..-R)k --N.. -•----------------......."'h!%.-•---•------. Contractor's Name.._ Q- A --------- � �.. e ....... Installation will serve: Residences Apartment House ❑ Commercial ❑ Taller Court ❑ Motel ❑ Other ❑ Number of livil r s: .___ Number of b rooms 3--_ Number Laths _ ___ Lot size .../0-_._._11,90, ER—S�--------------------- �i g 'l I' �I # 1 =2 . ft. Water Supply: Public system ❑ Community s stem ❑ Private 0 Depth to, Water Table `..,!.7 tt F Character of sodito depth-of 3 feet: So ravel ❑ Sandy Lamm-❑ ; Clay Loam 2'Clay ❑ Adobe❑ Hardpan ❑ 1 Previou Applicon Mader [I_ ayes,date_.-- ___y�.No New (ions tructi Yes .. FHA/VA: Yes ❑ No _ � - TYPE OF INSTALL ION A SPECIFICATIONS: - ; :a• or c 11'sII1 - with m 200 f e Septic Tankseptic taktancesfml Pearestfiewelfypubl Distanceroml' P �" `_......................... ou„datl n-- -- M 4 r�al1� No. of Co artments-.-____ __-_. Size___ 11 'q tid depth____.��____________Capacity.��o - I�i p ll --- ou?da�tio _��....___Distance to Weare t lot line.....-____._.. F• ell �. .Distance from f �� T D+sposal geld: Distance fr m nearest Length of each Iine7� ' --------------- of trench.l_____________________________ ! Number of 'lines----------- ________ ____ ' _. _ -_ _ yP I R -- P GA--.Total engt .._..---- --- `�-- ------------ b -------- lob j. T e of filt r materlali _Q-C. i- Depth of filter ma enal__ See a e'Prt: ! Nlumabe�of pts rest welly-L�iing mDateraal I from jou� Si� W Distance to nearest lot line_________________ ❑ ii. P e Diameter-------------- ---Depth_______- �_._..------------- ' Cesspool: Distancli� fl m nearest well_____ __________Distant fromou�ndat,7o Lin"i'n` atertel ..........._____ ❑.. : Size: Di'amater Depth t = - --------=-------Liqul Cap city '. �a--- -gals. Privy:' Distancel from nearest well______ ______________________ _______________.Distance from nearest building_-__._______________._... OPIS ❑ i Distance t nearest lot liras-=- -- ------------- I ;M1 -------------- -.------------------- •--------------------•----------------------•-------- Remodelin and/or repairing escr�4�e :--_i�� N. '0-P-tI_R__--M�i�R ._r__ -� g / P ' ing ( � � �`� � ...`f'G3--•---------•• ----------------------------------••---- ------ -- _�M ------------- - •--• , '' !�` '1------------------------------ - �4 �._------------------- -- '= aL --------------------------------------------------- -----------------t-------------- •---------------------------------------•------------`Y'------------------- -- I'hereb rtify that Ik,' ' preps this application and that the ork will be done in accordance with San Joaquin County ordinances Stat la an s and ulatlons of the San .1o'qu!n Loca Health Distric+ 7 r(Signed)= .._ .. :- _- - `-= .:::. t = _: _ - ---10wner-.and/or�Contractorl ------ --- - ------•- trileBY= --------------------- -------------------------------- ( I (Plot p(an, showing size of hot, location of system in relation to wells, buildgs, etc., can be placed on reverse aide). — ;I� FOR DEPARTMENT USE�uNLY APPLICATION ACCEPTED. $Y.- ___T._re_R_, c - ---------------------- DATE------- `- --------- .REVIEWED BY---------------------11;i------------------------ ----------------------- ------------ ------------•-•---•- DATE---------------------------•---._...---- ---------- BUILDING PERMIT ISSUE6---------------------- ----------- AMFerations an or�reGcrrim Indations ------------_---------- - --------4----------- ---------------------------------------------- --------- -------------------------------------------- ; ..-Z_ E3------ N l rpt. Tri ' I> - - ' ......` ------------ --------------------------------- ----------- ------------- ------ --------------------------------------------------- ---•------------------------ -1M ------------------------------ --------- -------• -• - ---- --------R------ --------------- - ------ �--- - ----- --- ----- ----- - ---- ------ -- --- ..................................... l FINAL INSP -C BY':_. Date------�_'_ ...... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street' 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California M`.onteco,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS ��':-- f