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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 77 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 Courcy Ordinance No. 549. EL 00 AA-4,0 S-r ' JOB ADDRESS AND LOCATION----------------Rt_.__1_J30X------171H19----Lathzop--------------------- ----------------------------------------------------- Owner's Name--------------------------------------------------MATED--M' SINTUE-GO-------------------------------------------------- Phone-----R!!!3_73$------------- AddressS-Ame:-------- --------I---- Pas_t___Xath_ews__Roa_d,___on---Hi---Way---- ---we-st---Side---of---,Ri---Way-------- Contractor's Name------------ INC-•------------•------------------- ----------------- Phone------9!n-9607------------ Installation will serve: Residence [] Apartment House E3 Commercial KI Trailer Court E] Motel E] Other F] Number of living units: -E] Number of bedrooms E] Number of baths [:] Lot size-----5__AC_r_e2S------------------------- I ----------1, Water Supply: Public system 0 Community system [-] Private EX ! Character of soil to a depth of 3 feet: Sand [:] Gravel [-] Sandy Loam 0 Clay Loam El Clay 0 Adobe El Hardpan Ej' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----rA01----Distance from foundation-----10t-------Material.-----C---C___Rri_Ck--------------I %] No. of compartments--------2----------------Capacity----------900---(Isi,e---56�'x3_6!!X-----Liquid depth--------52_1----------: Cesspool: Distance from nearest well________-_______Distance from foundation___________________Lining Lining material----------------------------------- ElSize: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_______-____________________-__________ ❑ uiiding------------------------------------------ 171 Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well------100-1-----Distance from foundation____10-t--------Distance to nearest lot line_--10,------ r] Number of pits------1-------------Lining maferial--CC:---Br-:LCNze: Diameter......33...........Dept k-----------lal------------- Disposal Field: Distance from nearest well_____6_0.1_'__..Distance from foundation-----101-------Distance to nearest lot line------10! xx Number of lines----------I------------------------Length of each line______50!_______________-Width of trench______2k'_'____________________ Type k'_'-------------------- Type of filter material------IP�---Rk-Depth of filter material--------181,------- Remodeling and/or repairing (describe):---------Nex--ins tal-lati-on.-S-ox---small---drdve-min---confe-etionary.. ----2--.t 0-ilet-S-9----?__--wash-_baaj-ns-,,-—and---usual--f jountain--facil;Lties---------------------------------------------------------- -----------------------------------------------------------I----------------------I----------------------------------------------------------------------------------------------------------------------------------------I ------------ --------------I------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I 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 r and regulations f the San Joaquin Local Health District. (Signed)-- -..--A ...P A DMI -----------------*-----------------------0--------------------0--------------------- Contractor) B ------ -------- -------- ------- __f-- -------------------------------------------------(Title)_____Rs_t_ima_t_or--------------------------------- (Plot ans, sh wing size of o , location of ystern in re[ n-to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ----------------------- DATE -------------------------------------------- Z:9"�-------------------------------------- REVIEWED BY----------------------------- - --------------------------------------------------------- DA -------- BUILDINGPERMIT ISSUED--------------------------------- -------------------------------------------------------------------. DATE---------------------------------------------------------- - Alterations ATE------------------------------------------------------------- Alterations and/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.1------------------------------•------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------I------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- ---- - --- - ----------------------------------- t ----- ----- ---------------------------------------------------- ---------- -- -- --- -------------------------------------------------------- - -- PERMIT No. __ _ ___ ISSUED'-- --- - ------- ------------------ (Date) FINAL INSPECTION BY:---------- Date---------------------------------- --- -- ---- -- �--------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639