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FOR OFFIC� SE:1.. ---------- --- -- ------------------------------ APPLICATION FOR SANITATION PERMIT Permit�.;, ---------------------------------.------------- ---I----- (Complete in Duplicate) ................. This Permit Expires 1 Year From Date issued Date Issued - eZ5'7 - Z`LO-0/ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de cribed. This apylication is made in compliance with County Ordinance No. 549. Kt?OA1 ._�`t:f-•..fnEc�44.�}` n JOB ADDRESS AND LO ATI_jD ------ - M_f N_TECfi-...._A_0....f_IQ.- ------ Owner's Name------•--------- —:------d__- ----- !�1 _G I` ---------------------------------------------- ------------- Phone---------------------------•-------- Address-----•-----•---- - 13Ox Z" ------------------------------------------------------------------------ Contractor's Name------ ��r- , I .P77 S .RV_i.C -------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence EjeApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � I Number of living unifs: __r:___ Number of bedrooms 3- Number of baths J__- Lot size ------fic-R. 19-G ---- ----------------- Water Supply. Public system ❑ Community system [Private ❑ Depth to Water Table 20- ft. � ?� Character of soil to a depth of 3 feet: Sand 2j-_"Gravel ❑ Sandy Loam ❑ Clay Loam R?—lay ❑ Adobe ❑ Hardpan ®'II J Previous Application Made: (If yes,date--------------------) No New Construction: Yes Z�'�o ❑ FHA/VA: Yes ❑ No��» "—TYPETOFINSTAL-L-ATI0W-ANDYSPECIFI CATIONS.�� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well_540-.-------Distance from foundation----Io_.__=f----Mate 'al C-0 a No. of compartments..._._..-__---_-.Size_y_)6_0-_x_-�.--__.Liquid depth_.-�f CapacitY.__/z. L Dispos Field: Distance from nearest well_!;F0...... Distance from foundation----I ---------Distance to nearest lot ---..- Number of lines-:------.�-----____-- ._____.Length of each line _ _-- Width of trench------- -`- ------ Type ----------- of filter material_---R-O Gi`_------Depth of filter material----___ 7-.-_----..Total length__________________ ----_----_ --- Seeps Pit: Distance to nearest well---,/Qp___.____Distance from foundation----/0_-_--_--.Distance to nearest lot line___ .----.- Number of pits__!��_.__.___-Lining material-..RAO C-K__Size: Diameter---9-X.14)-----Depth---------/Pl---I------- ----- Cesspool: Distance from nearest well-----------------Distance from foundation..:.................Lining material-----------.------------------------- . Size: Diameter---I---------------------- -- ---- Dept ----------------------Li Liquid Capacity -• gals. Privy: Distance from nearest well------------------------------------------------ Distance from nearest building----------------.-------------.----------- ❑ Distance to nearest lot line .� -- -------------------- Remodeling and/or repairing (describe):_--.5_X.5TEM_ ______ rY__.-__ -------- XPECT_FED-----7O_.__FUA1GTt0i'�-.--_________-- SC1TISr0GToAt-A `-----BV77 -1S-------N�-----APP_RaV�A-4----------41FFA( I----- 4-cntJE:_�-------lYlE (� -------Qt3t-y -------------P1-T�-- al�i��y 2 t�E._ 1dl �-�1d11�------�F__-----USA-L----------�A------------------ --Pl-T-------D-E?_'T-145-------�fO7 --` CH_r�cl�� ' ----RXXK----FJ-+-�Er>-------BSE Rf------YQS.f>�..Qri_-Q�v' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. s r(5igned} _ _ ------,---(Ownand/or Contraactor) z_ Br•��'. ------------ Title---------------- - ----- - ------------ - --------------- { 1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- .`� •® - -------------- ------------------------- ------ DATE...........�'-349- 11�6_ REVIEWED BY ---- --------- -- - --------------- - --------- --------------------------- DATE BUILDING PERMIT ISSUED---------------------------------------------------------------------- -------------------------- DATE . � ------------- ------ ------------- - Alterations and/or recommendations:__.__OP_04TRRCT&R..... ------ _____fr/QM_ 5 -_ GIIH- ------------------------ D----.="Tk�l4T. � �.......W..AS----- ------------- r1.�-T Mss- T a .__1_V0-------FvA-"rH_,>=3 ------Ac PN---------- CO_ -----------------------....----=----------- ------------------ --- --- ----- --------- ------ ---------------- ------------ -------------------------------------- ----------------------------- -- FINAL INSPECTION BY: Date. .-.-.-- ------------ ---- p SAN JOAQUIN LOCAL HEALTH DISTRICT k, 1601 E.ffazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street . -- Stockton,California Lodi,California Manteca,California 'Tracy,California F.R CC. }