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APPLICATION i,­A SANITATION PERMIT Permit No. -- .-�_�.a-__ <br /> 011 <br /> '3 {Complete in Duplicate) <br /> t - a > t fi Date Issued <br /> ► -. <br /> Appliea+ion is h reby made to the San Joaquin Lo l I Health District for a permit to construct and install the work herein described.- <br /> This application is made in compliance with County` Ordinance No:549.V NN 4 <br /> .16 11 <br /> JOB ADDRESS AND,LOCATION------- ----------------2 .._�,7.---.Lasalle St. S`tkt n. 41 ---------------------------------------------W eorfier of Mkt...-St. <br /> -----•---•-------; ------ ---- -- <br /> Owner's Name---Mrs; Fred .Westbrook t - behn em <br /> Address`------- -----116 N. Hine e = one- <br /> � ` `+ I <br /> Contractor's Name------------------------ t Dslt`f iSCptiC Tank erviCe;IriC: """ ne' 1"$0, 3 2 <br /> ►7 <br /> ---------- ------ ----- ---- <br /> I tl , <br /> Installation will serve:lResidence OC Apartment I"House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ <br /> f k 1 <br /> Number of living units`__--- Number of bedrooms -------- Number of baths -_----_ Lot size .---- 0 x 60 i <br /> Water Supply: Public system.,[j Community cyst m ❑ Private ❑ Depth,fo Water Table --4.5 ft. , <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel Sand Loam ` <br /> f ❑ y p Clay Loam 0 Clay ❑ Adobe gg Hardpan ❑ �,� <br /> Previous'Application Made: Yes ❑ No [3 New Construction: Yes []C No 0 . ; <br /> TYPE O(F INSTALLATION AND SPECIFICATIONS: k 1 f <br /> (No septic tank or cesspool permitted'if'public sewer is available within 200 feet.) i <br /> Septic ink: Disot nearestance from weli __._- _$Distance from foundation-------------=---n? feria# <br /> ExerNof com <br /> ting artme es °, { . <br /> p Size ----Liquid depth--"F -}----..Capacity-•------- ------ <br /> Disposal Field: Distance fFom nearest weid -__t:. Distance from foundation--------------------Distance to nearest lot line------.---------- <br /> - <br /> Exl3ting Number of lines------------------------- - ----Length of each line----------------_-----,------Width of trench--------- ----------------- <br /> € Type,:of fiifer material-----_ -----�_�------Depth of filter material---------------------.Total I g#h----------------F.-_---__-----_._-__--_. i <br /> Seepage Pit: Distance to nearest well.._._-- -_-----Distance`&om foundation.-_--10—': -__. 3 E <br /> ;t ' e-------- <br /> Number of pits---�- _.�----------Lining mate ria l------._0ek c <br /> maize: Diameter h <br /> e o ar t <br /> Cesspool: Distance from nearest weft---_-------__-_Distance from foundation--------------__ ..Lining m terial-_----.-------------- --- --- <br /> ❑ Site: Diameter----`---------------------1 -----Depth-------------------- Liquid Capacity g <br /> --------- <br /> Privy: Distance from nearest well------_. <br /> =------------.----- Dista <br /> nce from nearest building--------------1----------------=-. <br /> --- <br /> istanc%tc,nea.rest !ot line, <br /> n <br /> .. = <br /> - ---------------- ------ <br /> Remodelin and or repain' g (decri�e - aaaiseepsystem® <br /> ---- ----- --.--- to existing <br /> - - -------- -------------I <br /> ----------- <br /> - --- ---------------------------- <br /> , <br /> f ... -�'= `-----*-------- <br /> -- --- ---------------------- - _ - <br /> ----_••-_-•----_-_...-•-------•---_•----------------••-- <br /> ---"-- <br /> •-----__-------------------•_.--- <br /> ! •.F i - -------------•--- - <br /> I hereby certify that I have"prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and=regulations 4-'fh8,San Joaquin Local Health District. <br /> # N, .F <br /> (Signed)-----------D021a---I-efJt d-_TAnk--_SeT&. Ce-�`-Aq,►.-.---- <br /> ' .. - - and/or Contractor) <br /> ByPerrjWwGen. <br /> (Plot plan-,-showing-size-of-lot.locatiorelaiowfa well;buidings, etc., can be placed <br /> g <br /> on reverse side). <br /> Y <br /> g .w FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ,BY-_-..:_' #_. --- ------ ._- <br /> - -----• --- -----------------------E ------------------ DATE---------•.-- <br /> --- . <br /> - REVIEWED BY ---------------'---------------- ------ -- --- ----------- ---- -------------- ---------------------------------- DATE---------------- , <br /> BUILDING PERMIT ISSUED- 4 <br /> - DATE- -eq - <br /> Alterations and/or recommendations:-'... ._------ - <br /> t ----------------------------- <br /> ------------ ---•-- ---------------------------------------------------------- <br /> ------- <br /> - - - <br /> --- - -2 ---------------------- <br /> t <br /> -------------------------- <br /> ---------- <br /> ---- ------------------ <br /> FINAL INSPECTION BY------------ --- <br /> --G�-�.......----------------- Date.----- .�_`_11_.---5--�----- ----------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Sfreef 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES�9 145446 YYW00❑ <br />