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Fa � PERM '1' APPLICATION FOR SANITATION PERMIT Permit No. a # �39 (Complete in Duplicate) Date Issued _ _ s Ap Thiplication is hereby made to the San Joaquin Local Health District for a permit to construct-and install the work herein described. s application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----------96---S. Oro Owner's Name Tm py_'F.----Grahj 2—�4'�3 --•------------------------------ ---------------------------------- ------ Phone---------- ----- Address -'' Adelbart Contractor's Name..--------De t_a_'-Se-tic Tank Service ------------------------------------- - - -------- -- ------------- Phone.---.)-3953------ Installation will serve: Residence �] Apartment House ❑ Commercial 1 i ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --1 __ Number of bedrooms -_I-_ Number of baths -.___-_ Lot size Water Supply: Public system [❑ Community system ❑ Private © Depth to Water Table - Q- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes R1 No ❑ New Construction: Yes ® No ❑ TYPE OF.INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) `l Septic Tank: Distance from nearest well__5V--------Distance from foundation-A-1 KI • quid dNo. of compartments_-- ----__a---------Size- '1 °_X4-----_---_Li e thS143. P __ -�- --------Capacity---�-��----------- Disposal Field: Distance from nearest well--_-_�_!}-�____Distance from foundation__ R______- --__.Distance to nearest lot line_---_-,i____--, Number of lines-------- ------Z------------------Length of each line-5-0-1---------------------Width of trench----2! Type of filter material-_--rO_Ck---------Depth of filter material-__18-1-1-___-.__Total length-___5 _______________________ eepage Pit: Distance to nearest well------------ ------Distance from foundation_.-___..___-..___.Dista nce to nearest lot line----- --------------------Number of pits --------------------Lining material-----------------------Size: Diameter-----------------------Depth----------------- -- ------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------____-•ti+,�l�,r ❑ Size: Diameter_----------------------- -----------Depth---•------------------------------------------------Liquid Capacity------------- ga; Pnvy: Distance from nearest well---------------------- • -------------------------------------------------Distance from nearest building to nearest lot line--__---_____________ --------------------------------- Distance Remodeling and/or repairing (describe):.----_1n8t_2,j�,jng---5 Q.. a , _d__fl.f. I 2YY -ti- '_�x? " - c. l-- r_ -in. x-Fi.n_ito_be--..fil �. d Vin-with d�r� r - ----•---------- ----- -------------------------------------------P J k ---_.____ -- ------- ---------------------------------------- ------ ------ ----- ___-_. hereby certify that I have prepared this application and that the work will be done in accordance with--San Joaquin-_Co-unty_ ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I (Signed)------------------------Dejt-fi--j5ePt_:C---Tank_ Servic_2 {Owner and/or Contractor) --------------------------------------- $y:---------- .........Per'rY--Z� _rthdn 0� 0u=ner—M r. -----------------------------------------------(Title)--- g (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ---------------------- s APPLICATION ACCEPTED BY--- ------------------ DATE - REVIEWED BY --- ------- ----------- r� --------------- DATE---�cr BUILDING PERMIT ISSUED .y�— - ------------------------------- ------ DATE - AlterjnsX or recom n afions:� ------------------------- ------------------- -- ------------------------------- _1 ---------- ------ - ------ ------ -- -7 5 = -------------------------=-----1--`9 I/ ----4--------------------------------------------------- ------------------- - -------- -------------------------------- ---------------------------------------- - --- --------------------- FINAL INSPECTION BY---- ---- --- -- ----------- --------- ----------- ------- Date---------- --W4��t --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 300 West Oak Street 132 Sycamore Sfree+ 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 - r