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FOR OFFICE USE: Permit No. ------------------------------I-------------------- A!�.2 ---- ---------- APPLICATION R SANITATION PERMIT ----------------- --------------------------- I d (C ornplete in Duplicate) Lied Date Issued----------------- - -------------------------------- -This-Permit-ExiDires 1 Year.From-Date Issued ---- --- ---I------------------ -- --- Application is hereby made to the San Joaquin Local Health,District-for a permit,to�construct,aqd install the work herein described. This application is made in compliance with County Ordinance_Ko 549. 2, , t J_ ---------------------------_ ir ADDRESN -W S AND LOCATIO Phone_--------------------------------- Owner's Name------------------1_-—opla__- ----------- ..... .............................I................................ Address........15..7..q ........... ....... ------- ........ ............... Phone-----_------------- Contractor's Name----•- railer Court 0 - Motel 13 Other 0 Apartment House 0 " Commercial �$1870,1 Installation will serve: Residence [I 6r ... Number of living units: Number of bedrooms 777� Number of baths rl��_�. Lot(size ----/4<:R-J5P-- --------------- Water Supply: Public system El Community system C3 private I�Dellth TO Water Table ft. Hardpan.(3 IF I ��G - VC 1 ❑ Clay E] Adobe 0 depth of 3 feet: Sand ravel 0 Sandy Loam lay Loam C1 Character of soil to a d I A: Yes 0 No " V 114 ----) No �x New Construction: Yes 12�'No 0 FHA/V Previous Application Made: (if yes,-date--------- ...... -ACL JIFICATIONS: TYPE OF 10 ATIC AND SPEC available within.,21004eet.) (N9 septic tank or cesspool P-0i'mitt—ed if public sewer is avai % A -1--------- ----------- -Z dation.__._,h9---------material--- Septic Tank: Distance from '�Zarsstwel .om,f6un -Z'-Distance Jr Capacity----I-9g-p_ -.--- Disposal A Size:0.5( - -NS---Liquid depth----- No. of compartments-------------- . ..... nearest lot ist6\ off?om foundation_----- ------Distance to -in well- j ---------- v, Distance from nearest dth of trench ah/t 'Oer of lines..---------- --------------------Length E Dis P Field VOK of each line7------- -- -----------------.Width ------ .... ------------ F um "--_Depth of filter material----."1 --•-- -Total len gth ;P' eOf filter material_. - ---------- Distance to nearest lot line.. Seepage Pi;- Distance to nearest well"""-------------------Distance from foundatio Number of.pits-------------------_----Lining material-------- --------------Size: Diameter---_------------------Depth---------------------------- Distance from near'est well-----------------Distance from foundation--------------------Lining material--------------_----------_-------.-.-. aterial------------------------------------- Cesspool: --- -----Liquid Capacity ---_-__--gals. Size: Diameter.....................*-----------------Depth-------- -------------------------- -------_ 1,04 Distance from nearest well------------------------------------------------Distance from nearest building----•--•---------- ----------------- Privy: lot t1ire e .. _----------------------------------- 1e, -------------------------------- ZDistance-4o ne,dj,: ------ -60.0�_4 1 --------------- --------------------------- Rern ' - ----------------------------- ----- ---------------------- ----I............. - -I-------------------------.----------------1--- ------------------------ --I -------- ----ddAlng and/or repairing [describe):----- ---------------- - ------------- - _ - - -- ----- -- 1 - --------- -------------------------------- ............ ................ ---------------------- -------------------------------------- ---------------I---------- ---------------------------------I........I-------- --------1------------------------------------------------------ I : � I I ------------------------------------------- ----------------------------------------- ---------------------------------------- ---------------_-------.1 hereby certify that I have prepared this application and the fi& the work will be done in acconce with San Joaquin oun ordinances, State la s, and rules and reauI tons f the San Joaquin Local Health District.. - tt Qwiter .and or Contra f��rj ----------------------- ------- --------------- ------ t �(Signed) -------------------------------(Title)-------------------------------- ------- ------ ------- ...................... ------------------------------- By�........................ ). e . fc., can be placed on reverse side (Plot plain)0'showitig size of lot, location of system in relation to`wells,'buildings— FOR DEPARTMENT USE ONLY ---- DATE--------5 ZZ.-" -3------------------- APPLICATION ACCEPTED BY------77 -Rt7:0------------- DATE---------------------------------------------- ------------ -------------------- ------- --------- -:�) �5 E:F>74� ---------- - -------- - ----- --- -- -F--e ------- ...... DATE------------------------- REVIEWED. BY------------------------------------- BUILDING PERMIT Alterations and/or recommendations:--P!-K------W-!-TFf ------0------- ....... --------- ----------- ---------- ------- ......................... ------ --------_----- -—------ ----------------------------- ---------- .............. D_F --------------- ------- -- ------- --- I-A . ---------------- ........ T�_t - ............. --------------------- ------ --- ---- ------- ---•-- •- ---- ------------------------------------------------------- Date-------- --------- ---- --------- ...................... FINAL INSPE-C—T40bi ELY.-. SAN JOAQUIN LOCAL HEALTH DISTRICT 30o West Oak Street 124 Sycamore Street 205 West 9th Street 130 South American street Manteca,California Tracy,California Stockton,California Lodi,California ES.,.R REVISED 5-59 2M 5-62 ATLAS