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s APPLICATION FO. jANITATION PERMIT Permit. No. --._ •_ {Complete in Duplicate) Data Issued I ` Application is hereby made to'the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No..549. JOB ADDRESS AND LOCATION--------2©? . --- ; , ---------------------------------- • ------------•--------•-------------^--•-- Owner's Name---------------r�--&Sey__J_.__-1 1�Itin -1. --- ------- ------------------------ Phone__$0a.__3_-7323 Address _ Q'1l.__Et 7h 9 =tom, ----- - ----•--------•---------•---------------------- Contractor's Narine--------------DeIt"ajt fin ---------------------------------- ----=• --- --- Phone---H•--O•-.----3---•-7797-. Installation will serve: Residence ® Apartment House p Commercial ❑ Trailer Court [) Motel ❑ Other ❑ - Number of living units: 1Number of bedrooms -9---- Number of baths _�-___ Lot size ----__-.-6a_g_ 160 i • ----•-------------• ----.---- - Water Supply: Public system � Community system ❑.""Private`❑ Depth to Water Table ---45 ft. ` E] Gravel El -'Sandy Loam ❑ Clay_ Loa i E] Clay ❑ Adobe EX Hardpan Character of soil to a depth of 3 feet: Sand ❑ Previous Application Made: Yes ❑ No Ej New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: b ' (No septic tank or"cesspool perkfted if public sewer is available within 200 feet.) 11 Septic Tank: Distance from nearest well-----na_-----Distance fro foundation-------��---"-__-.M terial _-.-- ____"._______ f c. cement EO No. of compartments-------- 2-----------Size --,.4-1 x4''-_s Liquid depth Capacity 600----. Disposal Field: Distance from neo est well-"."--no--_-- Distance from foundation---_ 81A1�21e_"Distance to nearest lot line-_BID ,@: ® Number of lines---"J1"------------------ -"--Length of each line------_S_Q_i-___. ---_-.Width of trench--------2_'___•___-_- " Type of filter mat erial-----r-O-CSC--._"_-Depth of filter maferial---12°_:_- ----Tofal length-------_ ----SQ�,_.--------------- i Seepage Pt: Distance to nearest well _-"_II9_ �� y 1 ----Distance from foundation_._-$m 1..0 Distance to nearest lot line--- Ai,e ® Number of pits._"_"-__�._. _"____Lining material---_x'4?_0 _______Size: Diarrieter'__�;28u r ----.Dept h-------3Q Cesspool: Distance.from nearesf-well-----------_---_Distance from foundataon-- -•------ ---- -- Lining material----------- ----------------------- ❑` Size: Diameter---- -------Depth--- .--'------------------Liquid Capacity... ---------------- ------gals: s Privy: Distance from nearest well---- ---------------------------------" _Distance from nearest buildingQ ❑ Distance to nearest lot fine-_----. "--- w.. --------- --------------------------------- Remodeling ------------------------------------- Distance --=----------- = modeling and/or repairing (describe}: __.__"___-_Ile1P___$ $tetFil_______ `1 ' Re V ------ ---------------------- . -------------- ----------------------------------•----^-------------- ----------------------------------------------- -•----- - ------ --- --------•--------- - ----------•- --------f------ * t g :. , q ----- • ------ - ------- - - ------ 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 re ulations of the San Joaquin Local Health District. (SignB _p r `Tank 3ervicet-- Inc*-- ------------------------------------------{Owner and/or Contractor) ed)--------•------- --------I}e�,ta_^Septic-' Y k3 _s'y.-- BLx'thS11 -------------------------------------------- ' ----------(Title)--- aen-----Xgro-------------------- (Plot plan, showing size of lot, location of system in.relation to wells, buildings,-etc., can be placed on reverse side). I ` FOR DEPARTMENT USE ONLY` P APPLICATION ACCEPTED BY---------------------------------------- -- --- - ------------------------! -- ---- ---•------------ DATE---- -------------------- ¢--- 1r REVIEWED BY-------------'------------ --------------- -------------- � �", "`--------------- DATE----------------- BUILDING PERMIT ISSUED----------------------------------------- -- DATE------ - -----------------------------•------------- Alterations and/or recommendations% :_-":-"__-_"_.-_.__-" r ---- ---------- - ------------------------------------------------------------------------ ----------------------•---- .--- --- - ---- - - --------- ---------------I------------------------------------------------------------------------- O /�-----2._---�-? --------- -----------------------------------------------------I------------------- --------------------- ------------------------------------------------------- ---- --•-------------- -----------------------------------I------------ "n - ----------------------------------------------------------- ------------ --------------:----------------------------------- ------------------------- FINAL INSPECTION BY:" '_ - Date--.- / = -/l — J—� 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 i ES--9-2M Revisea 1.57 F.P.CO.