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FOR OFFICE LTSE: � APPLICATION FOR SANITATION PERMIT : Permit No. 175;4_7- ..- (Complete in,Duplicate) :w Date Issued 1f�Z r�..�l.Q This Permit Expires 1 Year From Date 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. /_ATHRS3p ri. r�.77E si Dl� f,t�'��c,si-�. r � JOB ADDRESS AND LOCATION_ IN ---- 0_....-----L? C,� I T RAJ. ----,--- .I i------------------- - v_I _ _Fr----- --------•---------------- ------------- Phone-----------I------•----------------- Owner's Name--------------�,��.L----•--- AVET Address ��. 1 Z �`••�- �----_r-�U'-�-------------��f�-�� -� ------------------------- Contractor s Name----- ---- •-WN�K--------•---------- :--- ----------------•-------- ------ Phone----------------------------------- i Motel Other lnstallatiors will serve: Residence ❑ ApartrrSent House ❑ Commercial ❑ Trailers � ❑ ❑ _ •. Number of living units: __,___-_.Number of bedrooms - Number of baths _-.!____ Lot size ___--- � ----• •---------- Water Supply: Public system ..�ommunitW�ICG_ ravel e-n ❑ _Private ❑ Depths to Water Table:_6__ ft.N } Character-of soil to a depth of 3 feet: Sand ❑ Sandy Loam [/]Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ 1 , previous LApplication Made: ilf yes,date-_..___.--. _...._) No ) New Construction:'Yes No El E HA/VA: Yes [] No TYPE=OF, INSTALLATION AND SPECIFICATIONS: . �„ ,;._r_. e{No;septic tank or cesspool permittedif,pulht sewer is evadable withi1�04 feef:��"'"°'�"" ff ) Septics nk.�„rDistance from'nearesk well fir_ _Distance from foundation f Material_ Qd ------- ,� . No. of.compartments__=__ --------- Disposal depth--_- - Capacity Disposal Field: Distance from nea_4stxwellC7_*.--Distance fromijoundation o Distance to nearest lot line_____ Number of lines___.--------� - - �`"""` -Length-of=eachJlne------7 -.Width of trench----- z.__ - -___._ Type of filter material-_R__O_C_ Depth of'filter-(material- _J. V__. Total length-------------------- Seepage Pit: Distance to nearest well-.__ _________ ___Distance from foundation e Distance to nearest lot line----------- ❑ �'' g Size Diamete �`�--- - -----Depth -------- ----------- Cesspool: Distance from well Lining stance �, p ' from foundation__-_._�"�""`.Lining material_____________________________________ ; ❑ Size: Diameter. - Depth------------------------ -------- -------==----._LiquidtiCapac'fy-------- ----- gals. i ------ Privy: Distanceafrom nearest buik in { Distance from:nearest well =-------- --------------- --- -- R 9 Distance to nearest lot line-------- --- ------------------------------ 171 x f Remodeling and/or repairing (describe)___________________ ------------------------------------------------------ •- -------------------------------------------------- ----------------------- •---------- - ------------------ -------------------- ------------ -------------------------•---------------------------------- I ---------------------------- - - I hereby certify that I have prep s application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, agzp the San .Joaquin Local Health District. h .. (Owner and/or Contractor) - ,(Signed) --------------------------------------------------- - - E� ... 4.Bf � � (Title) --- -------- --- .. ------- -- ---- y....-(Plot plan, showing•size of.lot, location of system in relation-to wells, buildings, etc., can be placed,on reverse side). e FOR.DEPARTMENT USE ONLY r° = DATE---------� Z - APPLICATION ACCEPTED BY n__`Q---''--------------- -- r REVIEWEDBY------------------------------------ -- --- -- ------ DATE- ------ ------------------ ------------- ---- ---- DA•TE------------- - -- -- ----- --- BUILDING,PERMIT-ISSUED-_ --- - --- =_= m.. Alterations and or reco men a to s:______ . " --- V T------------ ` - - ------- co._. . --- ------- `Tl�i� tAU_ el- 14- ' ?_l�[ST F = � lh------------ �•�"�-------RED- - 00-D--------1-IS------ rV�--- ---------- -------------- --•----- LL - 1 -- h. ( � ------ Date -----,-- �..�._ _. -- FINAL INS TION BY:_ ---------- i SAN JOAQUIN LOCAL HEALTH DISTRICT ,. 1601 E.Hazelton Ave. 300 Vllest oak,Street ` 124 Sycurnare Street 205 West 9th Street • Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISFO 9-59 31A 3.'63