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:FOROFFICE USE: --------- -----'- --------------- ........._.. AweLICATION FOR SANITATION PERS Permit No. _f v. ...✓..t' - --- (Complete in Duplicate) ,0��6 ..... This Permit Expires 1 Year From DateJssued Date Issued ......_ . .... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the or a ein de crbed. This application is made in compliance with County Ordinance No. �549. \ KoP JOB ADDRESS AND LOCAs N..Y.Y......EN.D...---oF......_ RCe4VlTF T4�. f/k d -------- 1 --- Owner's Name .............1 o --`-----------+-..Fl-x e.4a <1-1�� --------------- -...'.J'-'_------------------ hone.-----------' ---•------ Address---...----••.... -- . . - - X 1786 1.1 HRaI - - - -- $ - ...__......_. ----- ---- --- ------------ - Contractor's Name_.... \� -- ... e-------- -- ----------------- railer - ._- - - ---- --- ----------- - - - -- ----- --- ----- ------- Installation will serve: Resid ce ❑ Apartment Ho ��0 mezri81�' railer Court otel ❑ Ot r Number of living units? --. Number of be 00 :s� .- Num er of,baths ----...- Lot size ___ ..4CAE�F-- -----------_.....__ Water Supply: Public system ❑ Communit >;ys, ' Priva a[/Depth to Water Table -L ft�Character of soil to a depth of 3 feet: Sa Grades —S/a dy'Loam ❑ Clay Loam ❑ Clay ❑i dobe Hardpan ❑ Previous Application Made: (If yes,do ----'�_.. No �J' ew Construction: Yes o FAVA: s ❑ No TYPE OF INSTALLATION AND S�6IFJC[� I S: (No septic tank or cesspo I per�tit{e publAic�sew is available within 200 feet.) z v p Septic Tank: Dist/APefnr onT e�re£f•well__. ..._ _Distance from fou dation_--_�Q.._--.... tarsal-__;Y . --. ----_A-- ----------- l� No. par m s..... ..... .....Size..�2X_�7..X_� ...Liquid deith- ,,, gip i .,.r1 0 -. Disposal Field: Di m nearest' ell... ...... ....Distance from foundation.-_.fQ_.._ istance to nearest ne-.-,�_�_.. umber)D{. lines. .�.L�+�y�____ ____________Length of each line__-___�40.-__.�l__. idth of trd h.-_._.. . ...- _j'J6 Type of filter material_hQ..---'- -_.Depth of filter materiaL._.�� _.__- tat length__- r �0 i 7! - 3 Seepage Pit: *I'istancecear�st v1Ell......................Distance from foundafion__..7..___.._-_. Istpoce#o�r ares+ to me.............. ❑ Nu er o pits._.-_.__._..._.--..Lining material..__.................Size: Diameter._._.. _._-.-__.-.-__Depth-----_. .._-_._.......... Cesspool: Distancefrom Barest well.................Distance from foundation.: ------------- L ing materia-.......__... --____---_---._... ^� ❑ Size: Diamh�er.-...__...-- - -...Depth --- - - Li uid Capacity -f gals. .- Privy: -Distance from nearest welt........................ ----------.------Distance from nearest buildi _.�_.__. . El ♦<ii?v ?anf a ngaVesftlo1 lirib 13v•lo.�y...0 s y, .,e./--------------- .,►"r f---------- E Remodeling and/or re airing (describe) 17 7--6 .-_-- - ------- ------------_?111ESS. NED..--- ____R._._ ........ . ._!_fit-til - 1T>ES .._.s9P.T.r.c __T�! - - ''Q 40" !�� Act.! ----h� 131 rnisTAl - I�Onc�ntt4R_�_...-'`r��-A .- ------ ---- .vnIL-O. w!t,T�-------P"WeRD------FftFIV �- r -al....... .._- .. hereby certify tlrS J p epared th applic�+ion and that the work yrill.be doge in accordance with Sa'�i JoequipC�Coun+y ordinances. State laws�ad u es and,ret�iilations oft San Joaquin Local Health District. (Signed)_.r _.. .--- - -.-.----...---..---.----.---� + (Qsvner-a Rd or C� tractor) G By:.- . .......�......�..... - - ..-.. -- -................ .............. Ritle).... - �W----------------- ---- --�t - .... (Plot plan, sh siz f lot, location of system inlation to wells, buildings, etc,fcanbe placed on7�everse side). A V1 FOR EPART ENT USE _ E APP V11 N ACCEPTED BY------.-1-s.R..O_!---------- - ATE------ . -------- ... .. . of REVBY__...........................--.---'-- --...... --.-- - --------------. ------........--------..... DATE-- . - ------------------._ ......�-..._..... BUILDIG PERMIT ISSUED............................ ................ ----..—........... ................... DATE...................-......... Alterations and/or recommendations:----- -._r3�__a�Z - _ _.._1�QT -IN-- ... LxOF QRST___ .. RR¢¢�� .......�.F.tc-H. lL- .' .---'x-.......36-4-.._T. JELYt i4------11U..*-TSD 0�---- _ �1_ ?oj.r._._._. ---------BRO.KEtd.......V C-MI.E!-1ED.._..--e 1. -...... .tIl—_.._U6l;,=A_-- -I ------- t4_......T.R-.o..r.--_----------------------- ---------------------------- -------------------- -------- 1r --...................• - - - � ... - -- -- -- r; ....._ t........... FINAL INSP TION BY- -- -----pp -rr------- ''// Date...---- ----30--r---"- �----------------------- SAN JOA ?IOC�l3EI TH�ISTRICT �T 1601 E.Haxelton Ave. 300'4.8Dak Slrrs.n NJ 14 SyJ(o(a 5 rootf'�'� 205 Wase 91h Street Stockton,California Lodi,ColifCMJCQ ` ;JJ 1 Manteca,California Tracy,California Ca. \\ ES 9 REVIS EO 8 69 3M 3-'63 1.R. J _ r • _ ;�MTA.a