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A OR-05HCE USE: .. . f � �'-d----- Permit No...f_. �. � �z�,_ APPLICATION FOR PERMIT ------ - �.a :, in Du ]tate f��'� �°� = f-._- G (Complete P Da+e Issued -'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. j F4 East Hobart ------------------------------------------- -------•-------------------------- JOB ADDRESS AND LOCATION ------------------------------------------ Owners Name--------MFx`y--Cineros__:_�-AKA"�... Mar Mandu_&IlO-------------------- ---------------------- Phone.._. np...---------------•- Address-- ... 226 'Routh Anthony----------------------------------------------------------•--------------------------------------------•---- o.......---9-•-•----- Phone---- Ha.---��-g o9 ------ Contractor's se _tic Tank Service Snc ----------------------------------------------- - Contractor s Name.-- =-------------- Install_ation will serve: Residence ® Apartment House ❑ " Commercial ❑ Trailer Court ❑ � Motel ❑ Other ❑ 64 x 95-Q ---------------------------- Number of living units: -1..__ Number of bedrooms .2---_ Number of baths _ Z-- Lot size --------------"""-- Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table =_�--- + Character of sol! to a depth of 3 feet: Sand.❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ 'Clay ❑ Adobe*] Hardpan ❑ Previous Application Made: (If yes, date ._-"----------) No ® New Construction: Yes'a No .❑ FHA/VA: Yes E]----- No .` TYPE OF INSTALLATION AND SPECIFICATIONS: .(No septic tank or cesspaol permitted if public sewer is available within 200 feet.) Septic Tank: Distance from. nearest well ---- ------------- Distance from foundation --------------------- Material -.------------•---------- Existing No. of compartments, ------------------------ Size --------------------------------- Liquid depth---------- ---------------Capacity----•- Disposal Field: Distance from nearest well ---_-.-------- Distance from foundation -------------------- Distance to nearest lot line_..-__-..-".....- r^ i Egipt]4rig Number of lines ----•--------------------- --------- Length of each lane -------.-------- ------------- Width of trench-------------,---------------- Type of filter material------------------------ p Total length---.-.----------•:-----••------ De th of filter material--- ------------- • t' t Seepage Pit: Distance to nearest well--"-i1C¢--41, ----------Distance from foundation_--1�:-.__..__..Dista' ce to nearest lot line----axep--_ ® Number of pits-_.-_-.�"-"-_ Lining material--. MP -----------Size: 33 .. --------...-" Cesspool: Distance from nearest well ----------------- Distance from foundstion__""_--"--"-._-----.Lining material - -"-----als. ❑ Size: Diameter ---------------------------- --------Dept --- ------ -Liquid Capacity-----------•----- - :=• ;----•- ----- Privy: Distance from nearest well --------------------------------------- ----- Distance from nearest building ----------------•-----..____.""-_-"--"..-. Distance to nearest lot line-- ---------------------- ------ ----- ---------•-----•"--------------------------------" ----- - ❑ I repairing (describe) addln FilterF-Bed_ to_. existing-.shptiF----system------------------- Remodeling and/or re airin describe :_-- -- "- ---"--_�---- ---------- IL l - - --- -- ----------------------•----==------------•-----•---- ---- .,--------•-----------•---•---"------------- t 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. ... (Owner and/or Contractor) (Signed) --------p aAep! c -"Tank Servi_e_e,, Inc.. ------------------- - �aen- M r. --•--------- Title g-• ---------- ------------- By:-...---.-.P_s-rr-37---4-.--- W�,,rthan---------------------------------------•-----------•-------- - , (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR EP TMENT USE ONLY } ..� APPLICATION ACCEPTED BY"._. -.. - DATE--- �a • QATE----------- --- REVIEWED BY ------- I ...... •-"....... =------------------ -- - ----- - DATE. --- -------------------------------- BUILDING PERMlf�ISSIJED ---------------------------------------------------------- Alterations and/or recommendations: -_.-.-----.----�-----�-.----------- -------------------------•--- ------- Cy%(� - --•--- -- --- � -a ---- --------------------- --------------- }-------------------------- -------------- ------------------------ a . FINAL INSPECTION B ...-- ". .. _--. ---•--------------- --- Date- -------- ---•-• -- -- ----•----------------- - ----------------- E. SAN JOAQUIN LOCAL HEALTH DISTRICT `. 130 South American Street 300 West Oak Street 124 Sycamore Street 20S West 91h Street Stockton, California Lodi, California Manteca, California Tracy, California k ES -9 REVte E0 8.59 r.P.ro. 2M 6-60 II 1