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... -- p APPLICATION FOR SANITATION PERMIT Permit No- -----7. ._ � .. (Complete in Duplicate) ,,111 Date Issued ---T_-�-O�S� Applica{ion 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. r � t—pSa / y `16W2--7 S"•_ "lharl mIfFerry Road, Just south of lath-cop 21d. on right. JOBADDRESS AND LOCATION-------_----------------- --- -------------------- -_----------------: --------------------------------------------------------- ---------- Ut. 1 Box 392K, i�anteca (L -- ------ - Owner's Name------------------- Charles CLu3uiz3gham ----------------------......... Phone.M�tec 606 athro Rd. Address-------_---------------------------------------------------------------------•------------------------- -•---------- Contractor 's Name--- 2A .. c.I Cv '-..ass-1. Y(i--------------------------------•-------------------------------------------I--------------- Phone_110-- 770AQ-•---•-•---- Installation will serve: Residence IN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 8,0t• Court Number of living units: Number of bedrooms -.-_24Number of baths .12._ Lot size Psioh Water Supply: Public system ❑ Community system ❑ Private I1 Depth to Water Table ..4t. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam OT Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No Rk New Construction: Yes a No ❑ rr TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:3 Distance from nearest well.50.t---------Distance from foundation...-1:0=---------Material----COncretB ] 4 No. of compartments...2..-_---------------SizeKl__ r6�?.. L4.......Liquid depth__.4�".---------------Capacity.:- QO- -Gals.' Disposal Fields Distance from nearest well__6 .t.. Distance from foundation----:Q..........Distance to nearest lot line.... ..-_ Number of lines_---.-- 7tW ......' tu25 F 4 ------------ Len th of eachine..-.13 ............._. orenc . • •*' each----- w Type of filter material-------------------------Depth of filter material-----------------------Total length---.-------------------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_----__------ 4 � ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.........---------.----.-__--._-.----- J t ❑ Size: Diameter---- -------------------- --_Depth--- ------------------------------ --- Liquid ------------------ •-----gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building-------------------------------.---------- ❑ Distance to nearest lot line-- ------------------- --- --- --------------------------------------- ----------•-------------------------------------------------------=-- T,-ds application corers 4 corplete septic tank syr3t-r_�s for �h Remodeling and/or repairing (describe):----- ----- ----------------------------------------------------------------------------------------------------------- aa rt mei-t court. ---•----------- -••----------- -------------------------------------------- •----------------------------------------------------------•---------------- --------------------------------------------------------------- +s •------------------------•--•--------------••--------------------------•------------------------------------------•-••---------------•--------------------•--------•----------•-•------------------•--------------------- ---------------------------------------- ------------•-----------------------------------------•-•------------------------------------------------------------------------------- ----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. C ®AY&NIGHT (Signed)--------- --------------Septic-Tanlc_SesvirA------------------- -- ----=---- - -- - ------------ ----- ---------------------(O et-� Contractor) 1205 So. Eldorado HO 2- partner. BY: stoma Latif: ------------ -- {Title{ - (Plot plan, showing size of lot, location o system in relatio t wells, buildings, ., can be placed on reverse side). FOR DEPARTMENT USE ONLY =:�j - - --------------------------------------------------------------------------- DATE _ !"�-•----_------- ------ ----------------------- APPLICATION ACCEPTED BY_ Z........... .. REVIEWED BY ----------- DATE ----- ------- BUILDINGPERMIT ISSUED----- -------------------------------------------- -- ------------------------------------ DATE.------CA------------------------------------------------ Alterations and/or recommendatio��-------------------- ---------------------•--------------------------- . -------- -------------------------- -------------------------------------------------------------•-------------------------------------------•-----..... F3 -----------------------'---------------------------- -- ----------------- ------------- -----------------------------------------------------------------------------...---...-•--------------------------------------- =---------------- ----------------------'- ------- --------- ------------------ ---------------------------------------- -- -- -------------------------------..-.,. --- - ----- - 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 Tracy, California ES-9-2M 14"46 ATWOCO 12.54 {