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FOR OFFICE USE/ '' _. +��/ G'._..�—. ��P 0I�n u� �(, �r �• , Per No. ... ... l.'1_..� APPLICATION FOR SANITATION PERMIT ------------------------- --------- g ------------------------- (Complete in Duplicate) Date Issued --- ------ EI - ---------_---- ----------------- This Permit Expires 1 Year From 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. JOB ADDRESS AND LOCATION------- - RT.1s---BQx----85$-IA-thL'OP-1-...C�.lif-: Owner's Name-------�r' -G-r 80: H. RLIap_q l---------------------•----------- Phone.Hp•.••---- - 7 Address_... Above -----------------------------------------------------------------------•---------------------------------- ------------- --------------....----------..--------------------------------- -- Contractor's Name__ql ---'�'E�1'e'�,.Cr_...T.sL k__�l'eX'V.�ae J=*' ------------------------- -- --- -------------- Phone H�-=----'�--�1^26�----- Instaliation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Cour# ❑ Motel ❑ Other ❑ Number of living units: -1---- Number of bedrooms -2____ Number of baths -_�,.__ Lot size =______2__ACY'e8____________ _________________ Water Supply: Public system ❑ Community system ❑ Private l51 Depth to Water Table .25-lift. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made•'[if yes,date----------- ) No ® New Construction: Yes [2 No ❑ FHA/VA. Yes ❑ No [2 t ` TYPE OF INSTALLATION AND SPECIFICATIONS: Ile (No septic tank or cesspool permitted if public sewer'is available within 200 feet.) s Septic Tank: Distance) from nearest N ell_ ____________Distanceifrom foundation_-.___..-________.Material------------------------------------.-------- Exlift Ing No. of compartments-- ��---------- ---Size--------------------------------Liquid depth----------------- ---------Capacity..--------------------- Disposal Field: Distance from nearest well........ .. ... .....•Distance from foundation---.----------------Distance to nearest lot line----------------- ExIE]bI7g Number of lines---------=----- ---iLength of each line---------- ------------------.Width of trench------------------------------------ Type of filter material. .___ ------ _Depth of filter material----------------------Total length---------------.-------------------------- Seepage Pit: Distance to nearest well-'iQO--------Distance from foundation' __.LQ---------.Distance to nearest lot ` p , line_-__5-v__._ Numberof pits.-_.1---------------Lining material Diameter__--33'11---------- Depth---251---MaX,------ -- - material-_._-__._-.-_:_.-______.._-_____.._._. Cesspool: Distancefrom nearest well-----------------Distance from foundation Lining Size: Diame#er--------------------------------------Depth------------------------------ ------------�---___Li Liquid Capacity----------------------------gals. II -_.____.__._Distance from nearest building 9 Privy: Distance from nearest well___________________---____-, ❑ Distance to nearest lot line----------------- -------------------------------------- Remodeling and/or repairing (describe):------1ns_U_j1�ng ._F_Lj7t-j=-vbed-----------------------------•-•------------•----------------------------------------- ---------------------------------------------------------------- r --•----------------------------------- ------ - - - ------•- ------------ --=------- --------- ------ ---••- ---- ------- I hereby certify that I hav6 prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i [Signed)____ (Owner and/or Contractor --------- -Delta°--u�.�t�.�---T�nk_�_�rice-r---�•------------ --------=------ --------------- Perry VTarthan rile aen�:._M -r:--- ---------------------------- ------- ------------ ------ BY= - ----. (rifle) ` [Piot 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 APPLICATION ACCEPTED BY----- --- - ---- ------------ DATE (` REVIEWEDBY----- --- ------ DATE---------------------------------_----------------------- BUILDING _-----------------------BUILDING PERMIT ISSUE_Di ------------- -------------------------------------- ---------------------------------------------- - DATE--------------..---------- ---------------- ----------------- --- i - - --- Alterfio and/, r commendations:. -•----- ------ ------------- -- --- - ..------------------------------------ ._.' � - ------- -=--- z�°`.. --------- r--r--------- ----- -- .� - w ; --- A4 `f - - .��G��V �� GGcu 1=� BY:.----�- - yam':--=`---- _ SAN,JOAQUI CAL HEALTH DISTRICT ` est Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California / E6-9 REVISED B-59 F.P.Ga.2M 6-6a �I