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APPLICATION FOR SANITATION PERMIT /�b V Permit No. . .� -..._ (Complete in Duplicate) �' Date Issued ----1---- --------- Applica+ion 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. t._t9 ce_� " % on north side Of west Lo cke f o rd Rd. JOB ADDRESS AND LOCATION..----1I2--u -.ice t- af.Lo,Zkef_0,rA-----on--West---l©ekef-o-rd- Rd:--------------------------•- - -------- Owner's Name. -------------Chester . IA cake --- -. Phone---------------------------------- - Same--*& Locke fo rd------------------ --- Address • •------------ Contractor's Name--- 1� Cc -- R '. Y .------------ ----- Phone-- - 27046. Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other p Number of living units: ---a-- Number of bedrooms ---3--- Number of baths -A--- Lot size -----g---15.0'----------------------------- Water Supply: Public system ❑ Community system ❑ Private &] Depth to Water Table .49' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam M Clay ® Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes Q No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 0 Septic Tank: Distance from nearest well-----5P'----Distance from foundation-_5 l------..__.Material--BC--$ 'i&-------------------------• EK No. of compartments....2--------------------Size---72"�I?�'---X-------Liquid depth----67-`+___-----------Capacity-1000--Gals Disposal Field: Distance from nearest well--bQ........_Distance from foundation.--- 0.........Distance to nearest lot line_-_--101...--. Number of lines---I.-----------------------------Length of each line-----75.'._------..------..Width of trench------24------------------------ Type of filter material---.3pt�._c_-Rk Depth of filter material---- length-----75'--------------- ------------------------------ Seepage Pit: Distance to nearest well----110.'-.------.Distance from foundation-----5O.___--....Distance to nearest lot line---19'---_--- :K] Number of pits.... '_______________Lining material---Brick-___-__-Size: Diameter--.42..............Depth....... 5'---_--_----- I Cesspool: Distance from nearest weld-----------------Distance from foundation--------------------Lining material------------------_-------.-------- A ❑ Size: Diameter--------------------------------------Depth-------------------------------------- :--.-Liquid Capacity_........------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----.------------_---.-.-----..---_-----. ❑ Distance to nearest lot line-- ------ -------- --- -- -----------------------------------------------••------------------------- Remodeling and/or repairing {describe):___--...Ti0 pasis Cal. Yet--------for Iodn_.PurpoBes---------------------------------------------------------- ----------------------------------------------------------------------•---------------------•------------------------------------------------•--------------------------------------•-------•-------------------------------- •------------------------------••--•----------•----...----•-----------------•-•---...-•-------•-•-------------------•------------------•---------------------------------------- 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 regulations of the San Joaquin Local Health District. --------- DAY&NIGHT ' (Signed) ------------ - - -e- - --------------- --- ills, ------- ------ ( r Contractor) i5epflc 'fanTC Srvice Partner By:---- e...l2Q&S*,.Eldor.oda.--MO-2,7,V. t------------ - i - ----- Title) ------------- ------ (Plot plan, sho ne of lot, lofd*t gjtsgsiiiin in relation to buildings, etc., an be placed on reverse side). OR DEPART ENT USE ONLY APPLICATION ACCEPTED BY ..._....-- ---------------------------------------- ---- DATE------ -----•--------- ------------ ---------------- REVIEWEDBY-------------------------------------------- -- ---- ------ ------------------------------------------------------._ DATE------- - BUILDING PERMIT ISSUED. C-,.r-----------------------------------•--- -----•----------- DATE-------------- Alterations and/or recommendations:.................. -•-------- -•-----------------------------•----------------------------•- - ----------------------------------------------------•----•-----------------------------------------------------•-•-- ------------------------------------•---•------•---------••------------•------------------------- -----•-------------- ------------------------------------------- ------- - ------ ------------------------------------------------------------------------------------------•-----••-------------------------------... FINAL INSPECTION BY:. ..... ......... . ------------------------------------ Date------3.-'-.�Y, .S—� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 ATWOOD 12-54