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FOR OFF.ICE USE: <br />i•- <br />Li This application is made in compliance with County Ordinance No. 549. <br />Application .is hereby made to the San Joaquin Local Health District for a permit to construct and install the workmhertrein4d7cribed. <br />pi° <br />JOB ADDRESS AND LOCATI 0 N.tias....<01440 1710,1444/4.1._ . .110.?? itil•S 6 - <br />Owner's Name SCIVIll Sii0 • ii Ofi I 14 IRKiiiIIDON 1)1571:Ri.C.T7, PhoneeR.Zel'• / <br /> .070„,ez-E-e,..9, • c-.09.-t <br />Contractor's Na me 7-"--0X.-Dio#01/.44rF011170"; 4Worit'S Phone49.02 Vehr ,' <br />Installation will serve: Residence 0 Apartment House 0 Commercial 0 Trailer Court 0 Motel 0 Other <br />Number of living units: Number of bedrooms Number of baths- 'Lot size 4.771-.11.• "le <br />Water Supply: Public system 0 Community system 0 Private P"Depth to Water Table ./.#`. ft <br />Character of soil to a depth of 3 feet. Sand ffr"Gravel 0 Sandy Loam 0 Clay Loam 0 Clay 0 Adobe 0 Hardpan 0 <br />Previous Application Made: (If yes, date No E•"New Construction: Yes IA4o 0 FHA/VA: Yes 0 No <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />9NoWtio- tank-or--eirsigPol -perniitted4iffpubliesewireiraVailiibleithIn 261:ifiet:)z' <br />.1 Septic ,n4(: Distance fr`om nearest well SO DistaNe from foundation „140 ' Material CONKL2c-T -• <br />No. of compartments........ Size.V-Ki 0 X57 - Liqu'id depth. 1._2•-: *Capacity /249P <br />Disposal Fild: Distance from nearest well .S.(3 Distance from foundation IQ - Distance to nearest lot line <br />Number of lines -./ Length of each line 7$ Width of trench 36 -1 <br />Type of filter material..$04-.A.........Depth of filter material • Total length 75 <br />..ir) <br /> <br />I! <br />Seepage Pit: Distance to nearest well Distance from foundation Distance to nearest lot line <br /> <br />0 Number of pits... ... .— . . .... __Lining material Size' Diameter Depth <br />Cesspool: Distance from nearest well Distance from foundation Lining material <br /> <br />0 Size: Diameter. Depth Liquid Capacity. gals. <br /> <br />Privy: Distance from nearest well Distance from nearest building <br /> <br />El Distance to nearest lot line <br /> <br />Remodeling and/or repairing. (describe)•IVE-441 074-7ei:4.74e. *.gi:•;$feue. <br /> <br />ii ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ii • ii <br />- . (Signed)...... 7-1.e2.9%je '.'et°..r /..-- , foliOntier and/or Contractor) <br />i-,.......-1,..-By:. ... ..... 416.•,,OP...:- ...... <br />- • <br /> —,-,'"'=<..,'-- .,.. <br />_ <br />, (Plot plan, showing size of lot, location of em in relation >walls, buildings, etc., can be placed on reverse side). <br />II FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY. 77.13.).0 • DATE '2'--.ge - <br />ii REVIEWED BY DATE <br />BUILDING PERMIT ISSUED DATE <br />1 <br />Alterations and/or recommendations- <br />. FINAL INSitC-TiGN <br />SAN JOASUIN LOCAL HEALTH DISTRICT <br />1601 F. Itaxelten Ave. 300 West Oak Street <br />124 Sycamore Street <br />Stockton, California Lodi, California <br />Manteca, Carifornia <br />5.11, 9 214 1-67 Vanguird Press <br />- <br />APPLICATION FOR SANITATION PERMIT <br />(Complete. in Dupticatel - <br />This Permit Expires 1 Year From Date Issued <br />Permit No. <br />Date Issued .5.7.7._.3...7.4`.1 <br /> <br /> 4 <br />I hereby certify that Ihave prepared this application and that the work will be done in accordance with San Joaquin County <br />Date 7- 2 3 <br />I <br />, 4 <br />205 West 9th Street <br />Tracy, California