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r'VK Vrri;,C Uat: --I-------------------------------------------- PLICATION FOR SANITATION PE IT Permit No. . -- -------------------------------------------------------- (Complete in Duplicate} 3 -07 ate ---- ------- ------- - --------------- --- This Permit Expires 1 Year From Date Issued ..;,D�; f Issued 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 County Ordinance No. 549. Aelli // i-rECA Dr-- .aL9 RAKYQNJOB ADDRESS AND LOCATION-_, Vi S L1} 0 v � C � ._._. p••----.... Owner's Name------- YnZ___ ---------------------------------------------------------- Phone.... ....... .7...... ... �1S Address.......... � --...._. . _ Q ------•----•----•------•--.......... •-.......................................................... Contractor's Name.A1A1.V ECA........ B.P.1 i;=-----5- RSI'-1C- ••-• ... .............. Phone................................... ck, Installation will serve: Residen . Apartment House ❑ Commercial ❑ railer Court ❑ oteEi❑ Other ❑ Number of living unfits _ __ Number of bedrooms -��__-.. Number f baths � Lot size .__ - -................ Water Supply: Public sys ❑ Community system ❑ Private Depth To Water TaEilet 1.z ft. T ciw Character of soil to a dept eet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: Il es,date____________________) No New Construction: Yes�No ❑ FHA/VA: Yesy®r No ❑ TYPE OF INSTALLATION A i D�SPECIFICATIONS: (No septic tank or cess o I permitted if public sewer is available within 200 feet.) Septic Tank: Distance f o .nearest well--- ____Dista a from foundation__�Q..........Mate�i I... �. ,-_-__-. No. of corp r ments_:___ - *X/_Q x Liquid depth_.... - Ca aci I Q.C3J.- �*,.� P tY Disposal Field: Dis+anc. om ne res �f o : faun ktiorp-----/.Q........Distance to nearest lot line.. l........... Numb 1 1 es________ ______ � �' � _ _ ______Leng+h of eat ine'��.�t _�_.-._.Width of trench.-_-__��.___- !_.._..---••--- Type of file material...R®�-A----Depth of filter material-----.._..._---Total length,......... ..�.- Seepage Pit: Distance t- earest well__1IDi�___-----Distan a ram oun as ton "........ ist nce o n crest lot line.., .- Number o ts_., �___Lining material_ 4 1'�____.Size: Diameter�f X X___..__.:D pth------JV. �_______________ Cesspool: Distance f.0 nearest well_____-____..._Distan e from founds i R)IAR- �ininFinateri I------------------------------------- -Size: m t r.... Depth = qu' Capa p tY--------------------------gals. Privy: Distance Jflo nearest well---------------------------- --------------..--.-Distance from nearest building-- _----._-----.-_____-------------------- ❑ Distant to n crest lot line--------------------------- ---------------------------------------------------•---------•---•------ ------•-•-•---------.--------•-------- Q Remodeling a d re air n de tribe):--- TP C ------ ------ ----- � ----------- -- I/_-:__--------- •--• L =------------------ --•t r.=--••- !•-- ... pr.1�i.....7t?........n" )J35T. .------P/;....... .F ......5.70_-- -Q-F---•---1` �- -'P�........IN.C, �?- y 0.50---- ----FT _ fZ R0r_K____1Pr�L------- ��------AFTS------�-%AxN r-�•----1 -m---------HAft—t �i-----------r-m- 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 rules and regulations of the San Joaquin Local Health District. (Signed) -----------•------------------------ ---------(Owner and/or Contractor) By-Y .. ------ �� - --------- -•--------------------------------------------(Title-------------------•------------------------ --- -------------- (Plot plan, showing size of to ovation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION- CC PTSD B REVIEWf - A .�� •- - -�__-.------ - ----_------------ ......................................... BUILDING PERMIT ISSUED--------------------------------------------------------------•------------------------------- tbAf Alterations and/or recommendations:---•- -----------------------& ------------------------------------------------------ -------------------------------•-----•-•--------•--•--•------•---------------------------------- -------------•------•---.-.-----------------------•- N-D-----•-_--�R0_.......I_ ......---•-•---------............. •-----••------ -------------------------- ---•-------------------= ------------ ---------- FINAL INSP Date---------��----- r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 304 Wa:f Oak Srreat 124 Sycamore 5traal 205 West 9th Street I Stockton,California Lodi,California Manteca,California racy,California I ES 9 REVISED 8-59 2M 5.62 ATLAS