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Q" l APPLICATION FOR..,ANITATION PERMIT Permit No. 1•_ I. ._.. (Complete in Duplicate) Date Issued Application is hereby made to the San 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. 544. JOB ADDRESS AND LOCATION______________$807--_Don__Av, -3tk'n. Calif. ----- ---------- Owner's Name----2-et_er----anAA�atherine---Tru�-kiiq------------------------------------- ------- Phone_Gr.-- 7_`]-282 Address_6807---D33n__Av_'-- ------------------ -' Contractor's Name--------------------__ �� --- ------------------------------------------------------------------------------------------------------------------ -------- - Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of Living units: _3-___-_ Number of bedrooms 3-____ Number of baths _.1____ Lot size ____ _d0____________________________________ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table 1.__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adobe[a Hardpan ❑ Previous Application Made: Yes ❑ No X] New Construction: Yes ® No ❑ PHA/VA: Yes ❑ No bu 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----------------------------------------.-------- !- ---- Size--------------------------------Li Liquid de th..._----•••-•-•--- -- '-- Capacity EX�ti11g No. of compartments----------'_--y __ - 9 p, p ty....................... C Disposal Field: -Distance-from nearest•Iwell...j-----------Distance from foundation--------------------Distance to nearest lot line________-_____.- I Exerting i Number of lines------------ ---------------------------------Length of each line----------.------------_------Width of trench---------------- ----- ------------ I Type of filter material'_-----------I-----------Depth of filter material-----------------------Total length-------------------------------.--__-___-- Seepage Pit: Distance to nearest well----a.99..______Distance from foundation___44PIA_.Distance to nearest lot line--AMP-1-e. ] Number of pits-------2------------Lining material---X!QOX--------Size: Diameter_____33-----------Depth---a,Q t._____________________ Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material_______________.___________________ ❑ j Size: Diameter'-----------------------I-----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: I Distance from nearest well-------------------------------------------------Distance from nearest building______________________________________.._. Drstanceto nearest_lot line ------------------------------------------------------------------------------------------------------------------------------------- i 'l Remodeling and/or repairing (describe):---------------at�.�,; ng---2---8-e-epage--- �ts---to---xi$ting---my-stem--------------------- 4 ,� z i --------------------------------------------------------=--•-••--------••-------------------••---------------..----------------------------------------------------------------------------•---------------------------------- d I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County F ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. } � i (Signed) P011a---Septiq--- Flk---.` `Y,- --- I1' --------------------------------------- --Owner and/or Contractor Perry Walrthan By: ----...- `--{Title} ntgr� - (Plot plan, showing size of lot, location of system in relation to, ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- `i- �-�------------------------------------- DATE-----; -----�,--------------•----------------------- REVIEWEDBY---------------------------------- -------- ' -- ---- -•------------------------ ----------------------------- DATE --- --------------------'--•----•-' PERMIT;ISSUED----_---•-' �� ----. _ _ ,._,..--- DATE-_ _-- -� ,------------- -------------------- BUILDING Alterations and or,-'recommendations:_______.___._..__.__ _. �" k4 __=____'.__._____.. t :_- .... --------- I f – i-- ------------- ------------------------------- ----------- -----J j K i -------------- – pfd E----Y�. t+�------ /r -*-Q------ -`---K-------------------------- i ------------•-•-------------------•---•--- -•--•--------------- •- ---------- s1:1 ------ -- ----- ' 1z FINAL INSPECTION BY:___ - _ _ Date-------------- � ----_� �- — - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California a Tracy, California ES---9-2M Revised 1-57 F.P.CO- y'