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FOR OFFICE USE: r .. ._..... . . ... .... APPLICATION FOR SANITATION PERMIT Permit No. ... ... . ... .. . _... (Complete in Duplicate) -- Date Issued --- This Permit Expires 1 Year From Date Issued -----------------. � Application is hereby made to the Sarl,Joaquin Locaf Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549_ JOB ADDRESS AND LOCATION__-. ..,2a1.6 _ '+... 'i4 1.i.Q'. ......... - --- -- --------- - - ----- --- ----- --------------- • •_..__... Owner's Name......Irene---L:e.-.Be SQ.n. Address----------_------- "�'" 'st...�-..St_1k'n..�_. .Ca1Z,f,�.. Contractor's Name..__bel.t.a.. Sep.t1c_-'Llnk.5.4'TTJ,.;....Z1IC-•-�--------------------------------------------..._... Phone..HQis _.�5_... installation will serve: Residence E] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Ofher ❑ Number of living units: .--Z..- Number of bedrooms 2 . Number of baths ...1_ Lot size -._. - X_ 1-1.0____________________________ Water Supply: Public system 471 Community system ❑ Private ❑ Depth to Water Table -.45 ft. Character of soil to a depth of 3 feet: Sane{ ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ED Hardpan ❑ Previous Application Made: ilf'yes,date _. . .. . .-. ) Nom] New Construction: Yes Q No ❑ FHA/VA: Yes ❑ No 2] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S-ptic Tank: Distance from nearest well... TO ......Distance from foundation-1_0r Material_......_.C.*..-CCt73_�7?t.............. _ o. of compartments.. ........ . Size. a2_ ..r. ......... . -,dIpts . _......Capacity, Q:7 ... quid dep.th �_• Disposal Field: Distance from nearest well Distcnce from foundation....................Distance to nearest lot line_...____-______ � } u i 1 i;17 Number of lines_ -------------------- - - -,-._.Length of each line...._.--- --- ----.-.--------Width of french-------.--......................... N Type of fi!ter material--------- ... Depth of filter material___---____________._ Total hength..._._...________.____-__._-_-_--_-- Seepage Pit: Distance to nearest well _ ':D.......... Distance from foundation_-2-0-t_-_____-- Distance to nearest lot line.___) �._ .Ej Number of pits......1.-........ . Lining material-_f 7.6 .z.........Size: Diameter. Depth. . ..., Cesspool: Distance from nearest well_____________ _Distance from foundation .......___- . Lining material......_._ .._..- -------__..------. ❑ Size: Diameter- - - --- ---- --- - -- -- ---- Depth.......... - Liquid Capacity. ._..._.... ------..---...gals. - Privy: Distance from nearest well- . .. ... .. .. .......... ... . . . Distance from nearest building......................................... . ❑ Distance to nearest dot line Remodeling and/or repairing describe]:__ Cl?dlnq C2nf'7C.X11_.. ..-.-Geri1ejL _ae.�_: tank �.,3u �'A ,, + ..... a..?-f�� tv..w_Y r... ._ .,�_.._ �va..- .r. '_1.r�_Q, ...h '4y6._ fQ.r... :4torr .. r�...;:r;.t -r-. zn -----...._. - i-'!1A,..wa.t&r---. ,r;I ......--------------------...................--------------.------------------------- .........-----..--------------------.......................... ' ........ .................................................................................. ------.--------'----------.--......_.._..__.._..___......---•------__._.-.-`---------- ....................... .... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) :�.e ta._,7~£'�2K.1�'_..?'sy2< : ._.3.e_rv_V cep -'f=r....� ... Contractor .. ---- ..(Owner and/or ] By:-----=Jerry- v, lrtkr.�_.�.n re:�. 7� r� --- ---- ........ - •-• ---------- (Titley... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. . ................:t.......... ....... .... ---.------.--- DATE........... .............. REVIEWEDBY.... . ...... ......... . ........................................--- --...._._ ..------------------ ......... ------------- DATE.. -- -- ---------------------------------------- BUILDING -----------------------------------BUILDING PERMIT ISSUED........---------------------------------------------------L� ' DATE. - - 1. Alterations and/or recommendations:..._'��; f + _ 's _ � .c- L. ..-_--.---_-.-.. --------- ................ ...__-. .. :......--..-.-.._.... .... ._._................ -----------------..... .-. .- ---_------------------------------------------- ._... ------ ------.................----------............................-----------------......-------------------------------------------------------.------------------------------.........-------------------------------- i A ----------------...----------..._._._........... ...... ....... --- -__ - __-_-- --- ---_-_-_- ---- _-_..._---- _.-_------------- _......_.,.._..............__--_-- -------------- ------- ---------- _-_- r r FINAL INSPECTION BY........ ( SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soulh American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton, California Lodi,California Manteca,California Tracy,California -I s8 9 RtVi56o 5-59 7M 5.61 ATLAS I