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FOR FFICE USE: h i z of13' --____._-. AP LICATION FOR SANITATION PERMIT Permit No. ................ .... V 0--- (Complete in Duplicate) ------------------------------ This Permit Expires 1 Year From Date Issued 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. 549. JOB ADDRESS AND LOCATION...........409..South Adelbert .._ -Owner's Name................ O ..--•----------------- ---------------------------------------------•--._.. Phone...A9s....4"':91-7-... Address...........................kQ9...- ---Sodeert uth Alb- t ---d ------------------------------------------------------------------------- •------------------- ..------------ ------- Contractor's Name........DA:3i.14..SPS?VU...T'S1tl}C•_S@!T Agto...I P.�,-............................................ Phone...KQw....3#12.6.9... Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ---I- Number of bedrooms -__2_. Number of baths _1.... Lot size .... .............................. Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table -k,5._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeU Hardpan Previous Application Made: (If yes,date--------------------) No:C] New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No 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-----------------Distance from foundation....................Material................................................. axi8ting No. of compartments--------------------------Size................................Liquid depth--------------------------Capacity....................... Disposal Field: Distance from nearest well_________________Distance from foundation....................Distance to nearest lot line................. EjExisting Number of lines...................................Length of each line..............................Width of trench................................... Q Type of filter material------i.,. _J Depth of filter material-----------------------Total length.......................................... Seepage Pit: Distance to nearest well__' Distance from foundation-_14 s_.......Distance to nearest lot line.- .t IKI Number of pits..........It---------Lining material-__X'94--------Size: Diameter_....33__..........._Depth...2 ....max.* Cesspool: Distance from nearest well.................Distance from foundation....................Lining material....._............................... ' V ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well -------------------------___---__-___-_-------Distance from nearest building.......................................... ClDistance to nearest lot line---------------------------------------------------------------------------•---------------------------------------------................... Remodeling and or re airing (describe):_ _adding__Filter-H d- t •••existin system gj _ g--- - � ........................................... -•� `- Z ...,�<l�iu.-=fes. !<� _ 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)..................D0..1a..J5.019-�'.> k..a®1'1r iC Q a ..i .:------------------------.............................(Owner and/or Contractor) By:..............Perry_... ....Wfrthan....................................................................(Tt1e) --(den. Mgr' (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----J-------- -------------------------------------------------------------------------- REVIEWEDBY....................................... .............................................. DATE--•-------•--------•-------------•••......•-•------••-•.... BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE............................................................. &a+ion and/or re mmendations- -- ----------------------------- -......... . - - - ol /2447-41 n ---•--•--•---•--••---••--•-•......•'--...............................•---•-------------...---•-------------•-•---•-------- --...---•--...--•......................................•---••-••••-•-•-- FINAL INSPECTION BY:.- a... .. . . ........... Date E3 .. .. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E8 9 REVISED 8-39 8M 8'61 ATLAS