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......... ............................ ....:....I.._ A°PLICATION FOR SANITATION PER' 'IT /'Date ermit No. �....................... �z .vti ..... ................_..--......... � (Complete•in Duplicate) �.►f ---.- _.... ................ This Permit Expires 1 Year From Date Issued Issued .... :.. .'�J Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. em This application is made in complian a with County Ordinance No. 549. JOB ADDRESS AND LO ATIO Pw----�,r�.-.v..yATT`_......- z 1V ---__....0 LATHI�c.P -- }-� y�....... .... ........ ` Owner's Name ... ......L.t.l.000 l�.f. E fti__.._C4L/.�t:.... _ . .............. ..... Phone......., ... ............... . Address...................I-.91.......1r�1.. ...F_R.E.Y]!A... T.. ._��.(1.... - �'- T h 1 l Q 1 _......: ....................... Contractor's Name......GV4/..N_E_1'i...............--- ---. - .........__..... -_.'....... ......-_.----............................... Phone.................................. be, Installation will some: ResidenceNumber of bedrooms .. Comer of baths r [Motel ❑ Other ❑ ❑ p E] Commercial Trailer Court Number of living units: � / 4-.. -3... Lot size ..��R.EP.6 9! ._........................ r Water Supply: Public system Lys C om nunity system ❑ Private ❑ Depth to Water Table . G. ft Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobe❑ Hardpan 01Previous Application Made: (If yes,date_ Q� .-.__....__-.. ) NoNew Construction:. Yes Er�No ❑- IA/VA: Yes ❑` No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet) _ Septic 7 nk: Distance from neareifi welL....,,T. .._Distan a founcfa+iori 1 ........Material �C/`/ERETE .. No. of compartments.... ........._Size... ... or _......Liquid depth.....r.,.$' ... .. _..Capacity: S p----------- Disposal Disposal Field: Distance from nearest well _5.. ...Distance from foundatig .....�Q.......Distance to nearest lot line_-r....... [� Number of lines......._... Length of each .....Width of trench._..... Q... . ., Type of filter material... . ./1. >.....Depth of filter material_.._ZY......._Total length.......... Seepage Pit: Distance to nearest well...... ...............Distance from foundation....................Distance to ieardVt lot line......._..__.. ❑ Number of pits.-.,.................Lining material...............:...:. Size: Diameter......__-----.......Depth:._....._..._........... Cesspool: Distance from nearest well _......Distance from foundation ..... Lining material..s....................... ....._ ❑ Size: Diameter. .. ......... ._.. ._.............Depth.----------__.i..........------ .......:......Liquid Capacity..----------------.........gals. Privy: . . Distance from nearest v{ell .................._.__.,..-_____-._Distance-from nearest building L........:.:..............-.:---------- ❑ Distance to nearest lot lice Remodeling and/or repairing (describe) ....�� FRjOAA ..774NK.....-ExC.��?.. V -_y____ -L4�.1j-... ...............l4T .�-..t ....Clgb'Ic1.._ -T ' 11F .._'G�4&K.. -- .4Es ....-- T 'A.f�(. - - S�tFO- .'tdElr..__ticlr t-:`_.8�........Fit4��E� ...'�a------�7£ Fci .....LfiP.A�.67 �. --............... -- - -----------. ----........ - - --- . .. -...._...... .......___ _ .......--.. .......... I hereby certify that I have prepared thi3'application and that the iyork will be done-in accordaniia with e'San*Joaquin.County r ordinances, State laws, and rules and regulations of the San Joaquin Local Health D4tnct. )i (Signed).... — �S..j..: _ -- . and/or Contractor) By:--- ..................................................__ ................._. ... -............... -...................(Title)--........ .... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R DEPARTMENT USE'ONLYSee , APPLICATION ACCEPTED__BY_ .: R G DATE 2 r 7 _ REVIEWED BY .. ... ... .. . f .. . I/k1nlp ( ./IAR............ ................................�, . :.. . DlrTls-......7..:. .:... T . . . BUILDING PERMIT ISSUED........ .. _.--....: .. . --..........._._.......----- ........_.._..�.. DATE......._. ;- ........................................ Alterations and/or recommendafions:-----r -.......... . .`.......................,.....I— .............".`..................... ..... .......W. ........ - .......... -- ................................... ._............................... ----.................`................................... .....-......... - ........_.-.........._....-------••------------------ ..................._..----.....-•-------------*............._..----......-------..._....-...--------- --....._.. ----------- ...... ........................ .......-........... --------...---------- -------- V .................:----...... .............._.... .... ...._._._.. -' - -................__..........._.............. ......... .- ------------------ FINAL INSPECQ'....- - - .. Z :c�. Date...........` - -._ .... - .........._..... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasdron Ave. 700 West Oak street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi. Califomlo Manteca,California Tracy,California E.H. 9 2M 1.67 Vanguard Press