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/'FOR OFFICE SE: . " --.-_ _ � APPLICATION FOR SANITATION PERMIT Permit No. .....1..�...�S -- ----- . -- -------------- ---------------------- ------- (Completeli in Du Duplicate) P ) �/ 1r This Permit Expires 1 Year From Date Issued ' Date issued .................0/�.. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance'with County Ordinance No. S49. k JOB ADDRESS AND L- ATION........ ------- ........ `s ��` ' Owner's Name ---- 7 -.G- Phone------=----------------------------- -. r �- Address-----------•-------------------------------------•------•-----------------------•-------•-•-••-------------•----•------------- ------ - - Contractors Name . ........ y` - `.4 ---• - .. hprie.. Installation will serve: Residence R' Apartment House ❑ Commercial ❑ Trailer Court ❑ ote ❑ " Other ❑ � J� Number of living units: ..-.... Number of bedrooms __ -_ Number of baths . Lot size ...... -/ ........................... 1 Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table�? ft. Character of soil to a depth of 3 feet:t Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe[3 Hardpan ❑ Previous Application Made: (If yes,date--------------------) No R New Construction. Yes ❑ No Z FHA/VA: Yes ❑ No 8 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or csspool�pem itted if public sewer is available within 200 feet.) + SAptic Tank: °D+stance,.from,nearest ell-----------------Distance from foundation_-_----......_.--.-.Material,-----.--"--.--._...--._............__...... ,_ r 1_� of comparfm�nis.. ''�.---Size---------_--------------------Liquid depth--------------------•---.-Capacity-••----------•...----FDirosa'�F��eld: Distance;fro , nearest well-. -Distance from foundation.-.-_----____----Distance to nearest lot line................. x/s /�ber ofrline�---'•------------------ --�---.Length of each line------------------------------Width of french----------------------------------- ype of ,iliter material..............(AiA--_Depth of filter material-------------------- _Total• length........................- Seeps a Pit: Distance to nearestswelL�.� __^Distance f'r m foundation..... ` Distance to nearest lot Number of its - .l. Lin n "matI-Werial- - Size: Diameter-W-.. r"1_--__,De th----�a -'______________ P g � �� p Cesspool: Distance from nearest well.—,e--_---,y-_Distafice from foundation------------------- Linin trnaterial-.-.---_----___-----__-..---.._..---_ Cho ❑ Size: Diameter--------=-------------------- ---Depth ----------8.4.4=---------------- Liquid Capacity..- gals. - Privy: Distance from neare tSwelL_ -_----- A---------------------------------Dstanc&front�earesf�ing------------------------------------------ v1 ❑ Distance to nearest QNline-- ------------- -------''x.----- -------------_----------------••---,"---"•------------------••---•-- Remodeling and/or repairing (describe)----- d �---- ------- _ _„••-•• _ .10 ------------------- ......... -- ---.. . -••---•. ---•-••---•-. ! hereby certify that------ !A I have Are a ed thi- a----- ttion ------------•----------------------------------=------- --------*-----•-----------...-.------------------------------ - - d that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulates of Awre an oaquintLocal Health District. AS 114 (Signed)------- = /--------------------------� - .(Owner end/or Contractorl •' 0 4,111111f (Plot plan,swing sire of t, ocation of system in rt#latton (Titl.e) ----- :--------•--------------------------- Y• -- ` ells, buildings, etc., can be pie Id gn reverse side). 1 ij OR DEPARTMENT USE ONLY_jF APPLICATION ACCEPTED BY-------- ------------------------------------- DATE------ - -;tG - REVIEWED BY ------------- DATE------------ PERMIT ISSUED---------------------------------------- _.. ------------ - ----------------- DAME..-.------- Areconmen atons:.n ------- ---- .------. •-•-•--•-•-•------'-•--�•-.-`•-'•-----•- --------- ------ ---------------- - i ------------- ------------------- - ----- ..._ ............. - ` FINAL INSPECTION BY:_- -� . -. . � /�!��.�.g....'---1-o.l.,7 -G � Date-•------------------------- �?- �� 4 SAN-"JOAQUIN I-CAL AL-HEALTH g 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California , '•-`t:�8-S1 nEVl6 EP 5-89 2M 9-6f ATLAS � � ,� �{� - / _ /J�Y� �(� � � �/�`�i'rs-•j