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APPLICATION FOR,„ANITATION PERMIT Permit No. (Complete in-Duplicate) ,,. %,7 Y �D 'Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described.l This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-----------------3y'b3---A•___Mourfield_____-_ Owner's Name Albert---and__Li31ie- tanaP_ n,, _:::--- -Phone H°"' ..' _�fl3.-_. Address---------------- '� Maud i e d ., ---------]--------------------------------- Contractor's Name------- Delta-------- Phone -- ------------------------------------------------------------------------------------------ Installation will serve: Residence ® Apartment Hous ❑ Commercial ❑ Trailer Court ❑ Motel E] Other E] Number of living units: _1---- Number of bedroom's _----- Number of baths _1-__ Lot size -------5Qx10_Q------------------_----.-_---_---- Water Supply: Public system IS] Community system El Private ❑ Depth to Water Table 35_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam [] Clay E❑ Adobe{3 Hardpan ❑ Previous Application Made: Yes ❑ No�E] New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No PKI TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is'available within 200 feet.) Septic Tank: Distance from nearest well---------------I_Distance from foundation--------------------Material-------- ------------------------------- --.__. Ex[�eting No, of compartments------------ -----------tSize--------------------------------Liquid depth------------------------ Capacity----------------------- Disposal Field: Distance from nearest well--------------- from foundation---------------_-_-Distance to nearest lot line_-_-----___----__ Exmst ing Number of lines------------------------- ------- _Length of each line---3----------------------_---Width of tre ch..........._-------------------.-- Type of filter material-----------------------[Depth of filter material---_--_.---_---_---_--Total length- ----------- _-----__-_---------_---._. Seepage Pi#: Distance to neare t well---___-_�------------Distance from foundation_____- � �P��____.Distance to nearest lot line-----5-__.--__. Number of its-_------ 1__ rock " 2 1 ® p [ ----- Lining material----_-----------------Size: Diameter.-------33---------,Depth- -- ------------------- -- Gesspeol'.— .-....--.-•Distance•fromn'Le well-----------------Distance from foundation------------ ----- Lining material-----. _- _-_--.-----__---_______. V ❑ Size: Diameter - '___;_O------ - ----------De th---------------------------=--- p ------ Liquid Capacity gals. i Privy: Distance from ne hest well------------------- --------------Di nearest building-_------__-----_---------_____ ❑ Distance to neardf lot line---�_�___-__ ► Odin „$ee a it ., to existingsystem Remodeling and/or repairing (describe): = - ___ __p ------------------------------ -------------------- ----------------------------------- 11 ---------------- -------------------------------• -----------------•-----------------------------------------'---•-------•-=------------------------•----------------------------- ----•----------------------------- I he eby certify that 1 have prepared this application and that the,work will be done in accordance with San Joaquin County ordinances, State'iaws, and rules and regulation of the San Joaquin Locel Health District. I i r (Signed). AeJ._t_r -_ -�� e�.C---- I __sL V�xsTiCo ---------------------- ----------------- ------------------------(Owner and/or Contractor) - ---------------------I------- ; 1 Y - -x -a {Title) Gen. Mgr._:. - ----- - --------------- - B ----------------------- --------- art an _ err [Plot plan, showing-size of lot, location of system in relation to wells, buildings a fc., "b 6e placed on reverse side). FOR DEPARTMENT USE.bNg REVIEWED BAPPLICATIOY ACCEPTED BY--- _ '.©_- ------------------------------------- --f - DATE.- -------- DATE_--.----- ` BUILDING PERMIT ISSUED------------------------------------------------------------------------ --------------- DATE--------------- ----------------------------------------- Wferations and or recommendations:___----_. _ *� ___ ---------- - ------ -- - `°" ' D 'T k�- ------- x `r R X3----------------- -- -- -(-- . Nar eOrvN `r' p W¢- 7s-5-�----two ---------------------- ------------------------- ----=---- ---- ---------------F --- -- -------- -- --- ------------------- .- ---------------- ------------- t ,., , --- -- - -------------- - ;^ FIN N�PECTIOt��BY:.- � - -------------------- Date.-- ----- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1+,30 .South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street s 'Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revisea 1-57.F.P.CO. L.