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FOR OFFIC c USE: j ae^ "`- ji ATION FOR SANITATION PERMIT Permit No. ....03--61 ----- -------- ------------- --- --- [Coreplste inDu ficatep 1 Date Issued` R This Permit Ex fires 1 Year From Date Issued A� lication is hereby made tothe San'Joaquin Local Health District for a permit to construct and install the work herein described. pP This application is made in compliance with County Ordinance No. SOB ADDRESS AND LOCAT,ION. --------- QSS_.SOL: ...Slily-1-air--------------------•--------•-------------- •------•------------- •------------------- Owner's Name----------------------perry---and_-Bse-sSe---Ren_._ro---_--_-_--_..--------------- ---------------- Phone_HOe-477. AddressQ 'gQuh__.5I1caF='------------------•----------------------------------------- tic---T-�k-•-Service_x_._Inc,�--•------------------------- Phone..RQ o----3!"3.9-5,5- l Contractor's Name--------------D � Other Installation will serve: Residence (9 Apartment House [I. Commercial ❑ Trailer Court [I Motel ❑ El .__ Lot size�� ---------------------------- F ______________ F Number of living units: _ .____ Number of bedrooms __�___ Number of baths __7. ft. Private ❑ Depth to Water Tabi;45 Water Supply: Public system ® Community system ❑ Clay Adobe[]C Hardpan ❑ 11 t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ y FHA/VA, Yes ❑ Nam Previous Application Made: (if yes,date----------------"---1 No ® New Construction: Yes [ No [I TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) I,; Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------- of compartments_--_ -Size_______________•---------------Liquid depfih_-_-_---___ __ .----- ---Capacity_ E ]atin ----------------- k { Disposal Field: Distance'.from nearest well------------------Distance from foundation..__.____.---_-__--Distance to nearest lot line. Length of each line------------------------• -Width of trench E3Mstlng lines------ ------------------------- g , E��t,�ng Number, Type ofifilter material- -------Depth of filter material------------•------- Total,length--.----•---•------------------------------ T --- ' Ob — . .. x .._ +. ' ' f ------- R i Seepage Pit: Distance to nearest well-------- ---------Distance from foundation______1-_________.Distance to nearest lot ine__ l PO-q _ --Size: Diameter-----4----- ---..----Depth----6. G II ® Number of pits----__'1-_._------Lining material-___---___._ [ Cesspool: Distance from nearest well-----------------Distance from foundation---____.____. ----.Lining material._________.._..____._.__._____._____- ff Li uid Ca Capacity gals. .. Size: Diameter--------`---- ------- ------ -------:Depth------- ------------• ------....................... 9 p -------•----•---•----•---•-- Distance from nearest well--_------------------------------------------- Distance from nearest building - ❑ Distance to nearest lot'line--------------- -------- --------------------------------••- I adding.__41.x6- ---rQck_-�fill0d.._��m� �� _a�ix�g Remodeling and/or repairing (describe):__----______________ _ _ - � �,X]ill.--g�'!9&B_�~'t�=�--------- ±v'_�l�_Bw' iC�YlE'11 8-��3 --SIIl ._y11aBhiAg I11BLS'h 1B �� •---•------ ha; .---axt eat i 1"hQri_zont_al-_.1eaoh__drain--------------------_---------------------------------•------ --------- I hereby certify that I'have'prepa dalolf the Saand that n Joaquin hLocal kHealthleDistrl�}n accordance with San Joaquin County - ordinances, State laws, and rules aregulations and/or Contract Stgned A 1 __S-syPx Q-_ k �gE1"v ± e_,----lnr--.------------- (owneror ( )--- --- -.- Tttle Gent gr.-------- By:_..Perry--•OI_i_v_er-_Warl;han---------------------------------------------------------------------- ---- --------- -- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY --------------------------;---------------- DATE.--------`-7 -: 1 APPLICATION ACCEPTED B - _ DATE--------------- -------------------- ---------- REVIEWEDBY------------------ ---------- ------------ F -•---- DATE----------------- _-------------------•---------•---------:- BUILDING PERMIT ISSUED------------ -------------------------------------------------------• - /- ---- ---------------•----------•-----------•--- . trattans and/or recamm ndations:----- ---- -.= ---- / ----•---------------------•---•--------------•--••-- i� --- 3--- ---- % ---------------------------------------------------- - ) = ' ----- s em `---- - ----- --------- ---------------------------------INSPECTION B �^ ----- "� Date_ ----- FINAL Y: ---- �� SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 130 South American Street 300 west Oak Street Stockton,Californiafl Tracy,California Lodi,California Manteca,California Eg-9 pEVI5E4 8.59 F.P.CD,•dM 6.60 7Y