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APPLICATION FOR SANITATION PERMIT . (Complete in Duplicate) Application is hereby made to the San Joaquin Lo al'Health District.for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549, _ �? JOB ADDRESS AND LOCATION------Eid_ of_--G -_off---Qf--#IP---HJ-rWay----and--- -sty---raad--Pa&- -- �. Owner's Name----------__lrea'tlm Rd.. '� h-e liort-h 0.. - 'i R �� Tib O- - - - - Phone-t �_ 9 '---- -------------- Address-------��+-'---�:�Delt---��---��----�_d��-r---�s�,��..- _ --------------- - ---------------------------- phone_____ --- --- -Installation Contractor's Name------------- tt_a----------------------------------------------- ------------ Installation will serve: Residence [�t, Apartment House❑ Commercial ❑ Trailer Court ❑ Motel.—E].,,-Other ❑ Number of living-units: Number of bedrooms I] Number of baths [ Lot size____a.2,5__x-__91________________________---__--__ 'Wafer Supply: Public system. ❑ Community system ❑ Private [ Character of soil to a dep+h.of 3 feet: Sand.❑ ; Gravel ❑ Sandy Loam❑ Gay Loam ❑ Clay ❑.• Adobe ❑ "Hardpan n TYPE OF INSTALLATION ,AND SPECIFICATIONS: (No septic tank orcesspool permitted-if public sewer is available within 200 feet.) Septic Tank: (Distance-from nearest weli___ -------------Distance from.foundation_-------------------Material____:'-------.--------.---------------------__-- EXATING �No. of compartments-------------`-------------Capacity------ -----------=----Size--------------------------------Liquid depth-------------------------- Cesspool: Distance from nearest well,_ ______,_____Distance from foundation---------------------Lining`material-__________________________________- -------= --------------De th----_--------- ----------------------=------------ 'Privy: ---•------ ' ❑ Size: Diameter_____________ p• - 'Privy: Distance from nearest welf-------------------------------------------------Distance from nearest building__-________,__________________________._.• ❑ Distance to nearest lot lire------------------------------------------------ Seepage ____________________ ---Seepage Pit: Distance-to nearest weli------7 E_______Distance from foundation______,_8_1-------.Distance to nearest lot line___5t_____.__ f Number of pits---L----------____Lining material__BR-TOX------Size: Diameter____________________:_Depth_: Disposal Field: Distance from nearest well______---------------.Distance from'foundation -__ ..:"___.Distance to nearest lot lin -----------------�_____.____ G _ ..Number of lines---------------------------- --_-Length of each line-----____-- _- �-----W4dth=of-trench----------------- T e of filter material__________ De th of filter material____________ Yp Remodeling and/or repairing (describe)---------------------- ----- TAT, ___THEW---_�_ ------`-- AL ��_IN-------Qk?7 Igt'----'---_____ RF vant_s---drain---d Illed---�Q---lana which �s__��' -_•deep �ra�ae v eyards Surrounds . 1�e__:lvt___nut___in_--the___cnvntryt----�--Qnly----ene---hc��De---c1p�E---�bou�--600 ft �awa.V e --4thee house---has-- vert-iaal__drair_.-34-f_t_. deep---alre-adY---------- ---- - -- , hereby certify that I have prepared this application and that the work will be done in accordance'with'San Joaquin County-,. ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. Q .F [Si ned ------------------ 9 }------------��^.------ - ---- ---- ----- ------- ----------=-`--------" ----=---�_=9-�"`--•---------- -----------(Owner and/or Contractor) B • Perry Warthanl ,r Y - --- -- -------------------4-------------------------------------------------------------------------------------------(Title} ------------- - -------------------- 0wAer—Mgr- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). "F&PAP , @ FOR DEPARTMENT USE ONLY PPLICATIO ACCEPTED BY--------- >. ------------------------------------------------------------r �'DATE - - -- .4 REVIEWED B ------------ - ----------------- --- a+ - -- --------- - •--- ---- - ___. DATE---- ------- - ��,.-•-- ---------------------,---- BUILDING PERMIT ISSUED-------------------------------------------------- _ DATE----------------------- ----------- -------------_ Alterations and/or recommendations:----------------------------------- ---- i-------- `------------------------------------------------- ------------------------------------------------ ------- ----_ - N y --=----------------------------—------ x-----------------------------------�- ------------;---------------- ----------------------------- "l -J A_�" S (Date) ;FINAL PERMIT No. - ------------1 ION: BY:- --- --- - = ------------------------------- ------- �-� - _ ISSUED____ 1NSpaceT• - r ----- _f . SAN JOAQUIN LOCAL,.HEALTH°DISTRICT 130 South American Street Stockton;Califorri'�. ES-9-2M 9-5D W-1&39 s� k