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APPLICATION FOR SANITAPON PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> Applica-lion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in cornpliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION......P5 _.W.........Cbrnex-.__Harn_e.y__.LaneL---&_-Highw2y...9-9---------- ---------------- <br /> Owner's Name-----------qa.r.o.1_d.._Zec_hme.i_s_t_er------------------------------------------ -------------------------------------------- Phone..%maOkk O . <br /> Address <br /> ------------ ------- <br /> R- Calif. ------- -------------------------------i------- <br /> Address-------------............ ......... -------*----------------------------------------------------­---------_------- <br /> Contractor's Name----------5tP_i_Plor.Man---Goncre.Ve---F ipe---C_o_,,_,___Lo_d:Lj----C-alif------------- Phone__9fn35_9_6------i�--------- <br /> Caf q <br /> Installation will serve: Residence E] Apartment House E] Commercial [K Trailer Court [3 Motel C] Other E] <br /> Number of living units: -------- Number of bedrooms -------- Number of baths _----- Lot size -------------- <br /> _I.................. <br /> i <br /> Water Supply. Public system Ej Community system El Privafe .[Z Depth to Wafer Table _65- ff. <br /> Character of soil to.a depth of fieet: Sand-E] Gr'aQ .El� Sandy Loam-®" `Clay L-oa-m--E)�C-lay-[E]i;7-Adebe,[3—Ha.cdpart-L]---. <br /> Previous Application Made: Yes E] No 1] New Construction: Yes DO No El' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest weII150---f-t9istance from foundation----!Q-_;MOM ate rial�---C-o-ne-r-e-t-e--------------------- <br /> _-Liquid depth-..-------'- Capacity--.2-GGO--galf, <br /> No, of compartm6nfs---------4--------------Size_-­5__f_t_aLx54` ---------- <br /> Dispo;al Field: Distance from nea I rest well-1.5-0-.f.tWistance from foundation.._-10-.-f-t-.Distance to nearest lot line_----_---_.------ <br /> !,-.4 _-85---ft ..........Width of trench---2----f-t------ <br /> [K] Number of lines----- - 1------------------Length of each line ------------- <br /> Type of filter mate'rial--rock......:....Depth of filter material---_j-,B-- --------Total length----_------- ........ -------i----------- <br /> Seepage Pit: Distance to nearest wel!-----150'---ftQistance from foundation-ICLO---ft..Distance to nearesty rio.-t-t-4 <br /> P] Number of pits........1---..-...-_Lining material-coticnetfEize: Diameter2611...7-----------Depth-- <br /> & rock <br /> Cesspool:. Distance from nearest well-----------------Distance from foundation........._--------Lining Size: Diameter----- material--.-.--------_-.-.------.------ <br /> ---------------------------------Depth----------------------------- ------- ---- --------Liquid Capacity_------------------------(00 <br /> El I , -gals. <br /> Privy- Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> F-1 Distance to nearest lot line-------- ---------------------------------------------- -------I-­-------------- ---------------------------------------------------------- <br /> 1 4 <br /> Remodelingand/or repairing (descri 4 e)-------------------- ------------------ ------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------------- ......­-------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> - <br /> --------------------------------------------- ------------I——.4- ---------------------------------------------------------------------------------------------------------- ---------•1------------------------------------- <br /> I, <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordsinancqk, State laws, and,rules and!requla+ions of the San Joaquin Local Health District. <br /> �c <br /> SPIEKER G0.._#_--,--L0DT__ CALF. -ontracfor) A <br /> (Signed) ---------!��_(Owner and/orrC <br /> --------- -- --------------------------------------- <br /> --- ----- -------- ------ -- ---------------I--------6---- ---------------- --------------------------- -------------------------------- <br /> ing- � <br /> (Plot plan, show sie olfo�, location of system in relation to wells. buildings, etc., can be placed an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- --- . .1.71 - <br /> 34-- DATE-/D- <br /> REVIEWED BY------------------------------------- -1W .. ...... <br /> IA� <br /> ./­------------------ ------ -------- ----------------- DATE------ ----------------------- <br /> BUILDINGPERMIT ISSUED----------------- ----------------- ---I--------------------------------------------------------------- DATE--------- --------------------------------------------------- <br /> Alterationsand/or recommendations:-i----- -------------------------- ---------------------------------------------------------------------------------------------------------------11-11,11------- <br /> ----------------------------------------------------------------------------------------------- -- -------------------------------------------------- ---------------------------------------------------------------------- <br /> ----------------------------------------------------------------7---------------------------------------------------------------------------- --------------------------------------------------_--------------------- <br /> ------------------------------------ --------------------------------------------------------------- ------------------------------------------------- --------------- ------------------------- -------------------------- <br /> ----------•--•--------------------------------- - ------------------------------------ -------- -------------- --------------- --------------------------------------------------------------------------------------- <br /> Date. .--D <br /> FINAL INSPECTION BY:./r_,4 --------------------------------- ---------------- ----------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9 145446 ATWOOD <br />