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FOR OFFICE USE: Permit No. --- --- ------- APPLICATION F%--- SANITATION PERMIT ---------........... - ------------------------- j ,3-Q I Issued ---I---- ------------ ---------------- (complete in Duplicate) Date Date Issued t This Permit Expires I Year From Dat Application is hereby made to the Son 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. S49. JOB ADDRESS AND LOCATION---------408----W_f�----Ivy------------------------------------------------------------------------------------ -_ 4---9-8-0-H`--=4--3807------ Address Centeno ------------------ - ------------------------6------------- Phone ....--------- ----------------- Owners Name-------RPA;�P---- ... --------------m- - ----------------- -----------------------------------------................................... Address--------------------4-Q-8---K, __1YY------------------------------------------•------------•-------------------- Ho '1-7727 Se tic Tank SetV. Inc. --=---------------I_ Phone.......... :e----------------- Contractor's Name--------- --------------------------------------------------------------- ----------- Trailer Court E] Motel 0 Other 0 Installation will serve: Residence [2 Apartment House E] Commercial E] Number of living units: -1---- Number of bedrooms _.?---- Number of baths J--- Lot size ------------------------------------- 5 Water Supply: Public system IN :Community system [I Private.E] Depth to Wafer Table --.3----, ft.—] Character of soil to a depth of 3 feet: Sand [] Gravel [I Sandy Loam El Clay Loam a Clay (_ Adobe[] Hardpan F No F1 New Construction. Yes a No E] FHA/VA: Yes [—] Nod] Application Made. (if yes dcite__ _6 9�i,/ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'permitted if public sewer is available within 200 feet.) Ma.terial-----c-n-c-a-m-e-n-t nearest well no ---Distance from foundation....lql---- --- ________-_____--_"_. No. Tank: Distance from -------------- P�_h Capacityg 2 Alx�kl----- ----------Liquid cle --.34---------------- -------------- --- No. of compartment - -----Size I'm lot line--51 Disposal Field: Distance from nearest well------AP--..-Distance from foundation------- 0t-__--Distance to nearest -------------- rich Pq Number of lines------ -------------------Length of each line-------- -----------Width offre 4.0 ------- ---------------------------------------------- Type of filter'material--------X7.QjZX-.-, Depfh of filter material---- -------------Total lenh -foundation.__19 Distance to nearest lot lines_______._-__- Seepage Pit: Distance to nearest well-.---AQ-----------Distante from _251 Number of pits material-------------------rock-.-.Size: Diameter------33...........Depth --- -----------pits-----------I--------Lining Lining maferi ------------ ------------- cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material_"_______,________:---- F1T Size: Diameter----------------------------- ----------Depth------I- ----------------------------------------------Liquid Capacity..--------------------------ga S. istance from nearest building-------------------------------- ------- Privy: Distance from' nearest well-- -------------- ----------- ------------------D ------------_---------------I--------------------------------------- ElDistance t.o nearest lot line-- ---------------------------------------------=_------•--------------- to repj e ting-.-PIPtern ------------------ Remodeling and/or repairing [descr-$be):-------- gy-qP'A--- g�5� ---- - _ ------ ------- -------------- -----------------------------------------------------------------------------------------------------------------------------------I------------------------------------- ----------------- ---------------------------------------------------------------------------------------------------------------------------I--------------------------------------------------------------------------------------------------- -------------------- --------------------------- ---------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Countt y ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. or)......I rW..........I----------------------------------------I---------------(Owner and/or Contract (Signed)--------D-ell t 19 t---5.en t-1-a Tiank Gen. By:------_._Pjax!x:y--- -----Ag-r----------- ..................... (Plot plan, showing size of lot, lo;'afion of system'in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ----------- :7- .............. APPLICATION ACCEPTED BY--": DATE ----------- DATE.---------------------------------------------------------- REVIEWED BY------------------------------------- ----- ------------------------------------------------------ - ------------ DATE---------------------------------------------------- ----- BUILDING PERMIT ISSUED--------------------- —---------------- ------------ ----- -- ----------- Alterations apd/or dcomrnenclatlays--------------------------- ------------- ----------------------------------------------- .. ------------- - .C?-' —4 -----0Z ............0�51< --------------------------- ------------ —----------------- -------------- ----------------------------------------------------------------------------- ------------ ---------- ------- Date----x --- -- ------------------------------------- ---------- FINAL INSPECTION BY -- --- ----i-- ---- WSAN J AQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street. Stockton,California Lodir California Manteca,California Tracy,California 6-60