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APPLICATION FOR SANITATION PERMIT Permit No. __. ._.-/_. ,•-_ (Complete in Duplicate) f :� Date Issued k. Applieation is hereby made to the San Joa // 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. 549. ,�10 4 I JOB ADDRESS AND LOCATION--------new__ho-u ,-jj0_a-_.-g,f---714__S_.__Bla �---------------------- Owner's Name-1M''r -- a-ad--L�Y'8�-.. -Ua�,'e---Reyns7Lis--- L_ _ ----- ---- - - : : r Phone__7A Address ----------------i-•. uret.t--- ` ----- ------------ ------------------ Contractor's Name- ---------- E Installation will serve: Residence ® Apartment House L] Commercial Traile r�Court Motel Phone__ : --- .- - ❑ fiel ❑ Other ❑ " Number of living units: 1Number of bedrooms ---2_ Number of baths _1- Lot size ---- . f Water Supply: Public system g] Community system ❑ ��'"�-�-------------�------�----- I Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam Clft Previous Application Made: Yes No ❑ y ❑ Ado Hardpan ❑ ❑ [� New Construction: Yes ❑ No ❑ .. TYPE OF INSTALLATION AND SPECIFICATIONS: '__1 M (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----50.1----Distance from foundation--- " a r literial._-cement----- i�C® f)e) ® No. of compartments..__2----------------Size_-6'Z--X4y_-_x . -Liquid depth�.,2__ 43-- -----.--Ca acit - --- _- '�tOp to' Disposal Field: Distance from nearest well-----_5-O.r-.-Distance from foundation---1O_ _,Distance to nearest loft linea _- --•� ® Number of lines------1 --_---------------Length of each line- -__ -# "1 Width of french --_------- �� { Type of filter material------rock 18► " - .-- ______Depth of filter material_______________________Total length___�,�•'�pp-t�;�� Seepage Pit: Distance to nearest weil_LQQ t......... r p Dist undation ___JQ� Distance to nearest lot,line ....... .__._.- Cess ooL• p ---Size:' Diameter--- _ }�------Depth-------- - ®� Number of hs._ _ _ .L-__ - Linin material ------- ------ ante from nearest weft----------------Drs+ante from foundation------------ 3z --------------- material-----------_----.---- RC1. ❑ Size: Diameter-------------------------------------Depth_------------ Liquid ,Capacity_...__-- -----------gals. Privy: Distance from nearest well _____--- -_-__ ------------I- from. nearest buil�in ❑ Distance:to nearest lot line __--___. g -- -------------------- -.---- ----------------------------- - --------------- ----- Remodeling and/or repairing (describe): 1QQg- t�_L�-- CmTl , _i,?X, Gk---Sp 6 ` to t,p t� Ca t0 �,o bcatta� -4-•tat.�a.L---of 21- 't�. of.__�s�li3__ r Ali:. ------->o , n€ -•-U 42 h0...3. �b�:��ve�'�i Ica ------------------------------------- ------------------- 37 •---•------------ -------------------------____-------------------------------------------------------_____________._____________________ ___--__-_____. i 1- ' r g'. I hereby certify-that I have prepared this application and thaf,the woA wrll�be done in accordance with,San Joaquin Counfy ordinances, State laws, and rules and regulations of the San JoagU* :Local Health District rc (Signed)..--- t i 0 By-_-----------------PeL'>= r--�i►� l Wner,and�or,CohtraCtor} f �-- (Tytle)Y r G1. . X11�_ Mir'. (Plot plan. showing size of lot, location of�syatem in relation,#_o wells,; buildings, etc., can-ibex placed on reveise-side) FOR DJPARTMENT USE ONLY r APPLICATION ACCEPTED BY. 110 -- . - = --- DATE __ _ ;_' REVIEWED BY = DATE d, BUILDING PERMIT ISSUED- __-- - ;. ----------- --- - • DA E Alteratio s deo 3 _ s i, r recomm rsda �s p __ ____________________ -ti r b. _ ________•___ __ FINAL INSPECTION BY::__Stockton. California - Date / b - SAN JOAQUIN LOCAL HEALTH DISTRIC ff 130 South American Street 300 West Oak Street _ t e 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California 7reey, California ES-9-2M 10.52 Revised W-2100 -