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_ , - „vm%atF1%_r_ vac: ------------------------ ------------------------- 07— /44/ -------------------- -------------------------- P ------- APPLICATION FOR SANITATION PERMIT Permit No. -------------- --------------------------------------- (Complete in Duplicate) a us ---------------------------- -------------- erm:& c--:--- -1 Year From Dat Issue This IssueD to I d Application is hereby made to the San Jo ui Local Health District for a perm A- mallThis application ; it to con uc and Ttho�WplregeZrii, es s made in complian unty 9rdinance S IP B ADDRESS A D LRCATIO --- ---------- --- .. ............ nor's me -------------......... .. --------------- e0jo, Name. .. . ....... ..... ......;:, .... .... Phon . F... Address.................X4.V .... ............ ... ................. ... ......................... ---------------------------------- 6-YX i;el Contractor's- Name..!ZQ'21C ---------------------------------------------- Phone. 4 Installation will serve: Residence 7',�A'-partment House0 Commercial E3 (T�9,�Ie)Court C] Motel C] other Number of living units: .-/-- Number of bedrooms - _..�ber of bath. size size '6-`C6mMunity system bedrooms [:j Depth L s ---------- Water Supply: Public system _;/Lo after Tabl Character of sail to a depth of 3 feet: Send El Grav I ❑ Sandy Loam`` clay Loam;rClay 0 Adobe 0 Hardpan 0 Previous Application Made: (if y!Rs,dat,6t -------------------) No 0 New Construction: Yes M No El FHA/VA: Yes 0 No ❑ TYPE OF INSTALLATION AND'SPECIFICATIONS: (No septic tank or cesspol permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-nolzil-Distance from .foundation..'ja-1__..__.Material------ ........... -No�6f�cot-fipartme�nfs Sii=6:-J-6-(�' ---34-:'� .... -z:-Li,4uid+dep�h-,"- ity'..'.W."Po. r0.4_Z'j x 0�-3" apacI Disposal Field: Distance from nearest wellKfu_-..c___Distance from foundation----1.D._f__jE*$qnc to nearest lot line..__%T'._7 Number of lines-------'I- ----------m------------Length of each line t of ------- 1 6 trench Type of filter materiaI_,;4-A2�_.__Depfh of filter material_./_e__`1-------Total length......... -- --------- •Seepage Pit: 1/5-7 Distance to well_---------m.m-------Distance from foundation....... ........Distance to nearest lot line__-_.___-_---__-- ! ❑ Number of'pits----•-----------------Lining material---------_w----------Size: Diameter----_------------------Depth-------------------------w------ Cesspool: Distance from nearest well-----------------Distance from foundation-------------m------Lining[ material____.___---_-____, W......... 0 Size: Diameter.-------j----------m-m-----------------Depth-------m------------mm-------------- ----------Liquid: Capacity............................gets Privy: Distance from nearest well-______"____.-___1_% 0 Dista rice fo'nearest lot. line------ _.___-__"________________Distance from nearest,building-----•------------•-••-----------1........ --------- - •-------•- --------- -------------------*----------11--------------*1------- Remodeling and/or repairing (describe):---------- -------- -------------------M--------- .............--------------M.............. -------------------- ------------------- •--------------•------•-------------•---• - ------------------------M------------------------------i-------------------------M-------------------- --------------I——----------_---M--------------- ------------�_M_-----------------------------:------------ , - I ---------------M.............M...........----------I------------------------M----------------------- ---------------M--------------- ------------------------------ ..........M...........----------------------------------- ----------- ---------- -----•--------------- I hereby certify that I lave'preSdied this'a0plication and that the work will be done in accordance with San Joaquin County ordinances aws, and rul6s an regulations of.the San Joaquin Local Health District. (Signed)-jl' X�__04444.* --------- ------------------- Contractor] By:-----------_---------------I__......................._ U) ---- -- --- ---- -- (Plot plan, showing size of lot, location of system in ielati to w.oil! ------- -di'on-'remverse"side)----------------------- --- 5:,iui can be place FOR DEPARTMENT E ONLY APPLICATION ACCEPTED BY.___---„--"________________"""."--__"""-_ - DATE ---- ------- -------- _r ----- _------------_---------- ----REVIEWED BY ---M----------- --------------------------------W---------------------------------- -- ------------------ DATE--'' --------------------- ----------------------- BUILDING PERMIT ISSUED--------............ DATE- - --- ------- ---------------- -------------M---------- Alterations and/or recommendations______________ �" i --- -------------••-------•-•--------------- ---11------- .......................................M-------- ............. -------------------------M---------- -----------------------....................................... ................. ------------------------------------------------ ---------------------------------------------- ------------ ------------M.......................... ---------------------------------- ---------------- ---- 10)/I ------- --------- ------M.........-M............... ----------------------- ------------ .................................. -- --- -- -------------M------- ------M- - ----------- --------------- ------------- --------- ---- -- ------------------- --------- ------- - ----------**----------*---------------* ----------------------------------------M------- ........... FINAL INSPECTION Date----S------- "_—"$-;2!---------— ------------ SAN JOA QUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak!neat 124 Sycamore Street 205 West.9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES ' NEVIS ED $-59 RM 5-61 ATLAS