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7 R OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .__L..l... ------------------------- ------------------------------- (Complete in Duplicate) 6 --------------------------------- --- -- --- -------- 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. Mrs. Margaret Me Miller 3439 San Mateo I JOB ADDRESS AND LOCAT.ION----------- ------------------------------------------------ - ----------- Owner's Name----------MargM_t__K.-_X__iJ1er---------------------------------=--------------------------------------------- -------- ------- Phone---- ------------------------------ Address-----------------------3439 Sall Mteo ------------------------------------------ -------•------_....-----•-------------------------------------------•-------------------------------------------------------------__- ....---- Contractor's Name--------------- ------------------------ ----------------------•-------------------- Phone---------------------------------- Installation will serve: Residence$] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1__ Number of bedrooms ---Z__ Number of baths .-Z.._ Lot size _.-.9�!. :.1, ?�f............................... a Water Supply: Public system ® Community system ❑ - Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EX, Hardpan ❑ Previous Application Made: (If yes,date--------------------) No .EX 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---i10i12 Distance from foundation-___1a 11........Materiai-------- recast- Concret. -. lid No. of compartments-----------2......------Size----- �7s:9`,_. -_-`Liquid depth----_-.54-7-----------Capacity-------W-------- G� I Disposal Field: Distance from nearest well____nQA9..Distance from foundation_---121-------.Distance to nearest lot line.....- 21.._.- �. 651---------------Width of trench---------Z .---------.... Number of {fines___-__.-______________ _______._Length of each line- Type of filter material--------S/R_-------Depth of-filter material .---------1Q"---.Total length---- 5.1-------------------------------- Seepage Pit: Distance to nearest well.....nQne-------Distance from foundation-----------25.T...Distance to nearest lot line....�,2�...... ® Number of pits-_.---3-------------Lining material*- -_SIR..---.-.-Size: Diameter.---------h8rr------Depth._..-251.._------------------ Cesspo& Distance from nearest well-----------------Distance from foundation____...._...........Lining material-..___--.-..-_.._____._____-.-_-- ❑ Size: Diameter-------------------------------------Dept�h------------------------------------ -------------Liquid Capacity---------------------------•gals. Privy: Distance from nearest well-----------------------------------------------1-Distance from nearest building....-......------------------------.-----. ❑ Distance to nearest lot line------------------------- --- ------ - ------ ----------------------=----------------------------------------------------------------------- - :Ar'1L.. Remo elfin and/or repairing,(describe}.:--_--.- Replace old tank add 65r of leach and one �8" dia. X f 2 1 deep seepage pit,_ ----------------------------t---------------- -------------- ----------•----•--- -------------------------------- --••-•----------------- ----------------------------------------•------------------ ------- --------------------------------------------------------------------------------------- ---------------------------------------------------------•------------ -------------------------------------------------------------------•----------------------------------------•---------------------------------------- ----------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------- -------------- --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joa--uin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r i i (Signed)-----------------D --arrisW__ ........------ - ---- ----------------- -------------- ---------------------(Owner and/or Contractor) p By: !�'--- -------- -- (Title) s_trtAr 1 (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 II APPLICATION ACCEPTED BY-------- ---- ��-------------r-- -------------------------------------------- DATE----------- J - ----- ---- REVIEWEDBY------------------------- ------------------- ----------------------------- ------------------------------------------- DATE.. BUILDING PERMIT ISSUED------------------ ------ G-- --- DA•TE- ------------------ -- ------ Alterations and/or recommendations:..-.___.- ....................._.. -------------- ------------ .� --------------- --- --- --- -------- ------ - - ----- -- ----- -� r --- -------...... _�------ c _ FINAL INSPECTION BY: Date ��'--------- 17---------------------------------------- FINAL JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California I` F.RC O- L