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F. ....... ........ 1 39 } ......... APPLICATION EOR SANITATION PERMIT,'. Permit No. .._-... _ �............ ................................ (Complete in Duplicate) _..__. This Permit Expires 1 Year From Date Issued Date Issued rQ . ------- opli , cation is hereby made to the'San Joaquin Local Health District for a permit to construct and ' 11 a wor herein described, .15 application is made in com iiance h County Ordinarc No, 549. �� 4 ?�� It— I �.:. , B ADDRESS A D LOCATION.. ' t ,' -- r '1 I Yner's•Name.. . . _.�' t[�t:2_r ,� + c" �'�4 ar�. _ .. . . \ •... ................ . . _.__. -•---....--- - Phone---••------.....-•----.._....-- kdd ress.......................... .. �.. .. . : _. -- - -- ' ---- ntractor's Name.1 4°C�� / pp ........... Phone4v _ •d__ ..�- �'1. ,.... nstallation will serve: Residence Apartment House Commerci I ❑ Trailer �1_] Motel ❑ Other 'Number of living units- ...._ Number of bedrooms __2�Number of baths __�:., Lot size __..___: ,;�. - - ,.--j, .:Z..3.+ ter` Supply: Public system ❑ Community system ❑ Private 29--fepth to W ter Table J�?." ft. w _ I ;haracter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Fvlous Application Made: {!f yes,date....................} No New Construction: Yes Io ❑ PHA/VA: Yes ❑ No ❑ PE OF INSTALLATION.AND SPEC IFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) it aticlTa Distance from nearest well-1-16-P.-.--Distance from fo dation._ _..._-. _ .. i /B. _ . terial................................... . ... No. of compartments..." .--- Size �7�. � '. ff.Liquid depth-- ,�!. Ca acit pose.I Field: Distance from neare t well. --Distance from foundation_-. _-f.....Distance fo nearest lot Ii ]' Number of lines.. Len L li gth of each line-.6�, Ez7�__ZPwidth of trench.,j;;.. /-- ...... I Type of filter material.- - .- Depth of filter material.-_.._l.� `r ' Total length..................1 .. seepage Pit: Distance to nearest well....:................Distance from foundation----------_---------Distance to nearest lot line................. ❑' Number of pits._._...........--- Lining mpterial...................... Size. Diameter..-----...__........... Depth...................... sspool: Distance from nearest well................ Distance from foundation....................Lining material..........................---._._ ❑ Size: Diameter............. ............ ....Depth------------. r -_---------------:-Liquid Capacity-------------- __gals. ,y: Distance from nearest well..................---------- ------- from from nearest building........................---..._ ..... r_ ❑ €. ." Distance to nearest lot line...............:�..-......... --�-- �- •-----._...-------------••--------- odeliL. ng. and/or repairing jdescribe}:......_............ .�"-----... _..•.......................... --------•"-----------------• - ............................................ ............................ -•---•-------• .........................• ------. .._...._. . ..._................................................ I hereby certify that ave prepared this application and that the work will be done in accordance with San Joaquin County inat ces, State laws, arxAmles and regulations of f n Joaquin Local Health District. cC�7� II �i �CJa �' 4t iened)._.... StP I a'-rA-NK' E:RVlCE:.----....... 1..... ...................•-----------•---......_... Contractor) By:..•--2915 E.Miner Ave., • H0.6-3841 G __.. ........................(Title).............................................. `lot plan, showing size of lot, location of system in r afi to wells, uildings, etc., can 6e placed on reverse side). y FOR DEPARTMENT USE ONLY a ,PPLICATION ACCEPTED ._.. DATE...--•-- _-. -S. IEWED BY_ ----• DATE----- . •.... . = IN PERMITISSUED................................. ................. DATE------------- -----•- ...-._ . arerations and/or recommendations........................ .......... ..................... .........................-----------•----......----...-•---....---------...----- ....._....._..... .._.__............................_... .. .............. .............. ----.- .................... F .. ................................... ....................... ........ `... ............. r s ............................ ............... J ...... +_._AAL INSPECT40LL �1��. __..._. . Date..........--•-��—..-.C1...77.�."...r SAN JOAQUIN LOCALHEALTH DISTRICT i 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 41 205 West 91h Si'ree! Slockton,California Lodi,California Manteca,California Tracy, California r.a.co. I1