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FOR OFFICE USE: ------------------------------------------------------- � ----------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ... `.....7 `f.. ----------------------------------------------• -- (Complete in Duplicate) -4 ---------------- --- This Permit Expires 1 Year From Date Issued 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. S49. JOB ADDRESS AND LOCATION..MC.A_rth=--.Road_--J/_ ._-m l .-- Q-I� ...Of__. 111D.0_.R_.R.Bd----r---TT.�C ------- Owner's Name PaS_C�laQ .-Q3 C�1a� �' 7. -- CUnninehap9----qenl..0-ont-------•------•---•--- Phone..-T:A . ........ Address------------R teca Contractor's ' _ep_.ti.0_..T.ank__Seryl.ae----------------------------•----- Phone--0_63$ 1------- Installation will serve: Residence CEDMpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms .-_-'3.. Number of baths --a•* Lot size ----------------3.*-.ACrea.................... Water Supply: Public system ❑ Community system ❑ Private =Depth to Water Table -35. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel lK Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe 11 Hardpan ❑ Previous Application Made: (If yes,date--------------------)-No ❑ New Construction: Yes =No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION'AND SPECIFICATIONS rQ `(No ii —ossp`ool permitted if public sewer is available within 200 feet.) Sr<ptic Tank: N Distance from earest welL__�Qr--_--.piste an tx t t i �'`n foundat' -10_-_.------.Material-----��--BZ':LGk._._.� ..�. No. of compartments �, 6 "'' _Size - <icd de th____- -$!�___. _-._Ca aci 5 - +v els, Disposal Field: Distance from nearest well 5_0!------Distance fro f undation....2-0!--------Distance to nearest lot line_---_- f-...... Number,of lines---- -----------------------------Len th of each line-------- _ Width of trench......._-?— -___----_-----_---- - Type of filter material . 'p ,C_- kDepth of filter material----1 f----------- length-------------15.01 ---------------- Seepage Pit: Distance to nearest well-----IQQ--------Distance from foundation-----_- 0_-.....Dis an ce to nearest lot line----_---_4gals. Number of pits.....2--------------Lining material_._RQCk-------Size: Diameter----.3 --_-.--- Depth_---.-....ZQ11. .-Cesspool: Distance from nearest well-----------------Distance from foundation _::_......__`_..Lining material-.......-------__----_-.--_--Size: Diameter--------------------`-----------------Depth----•--------------------------------------- ---: _Liquid Capacity-------------------......ter-�.n -. _ ...Privy: Distance from'nearest well------------- ---___-----------_-_--.-_-_.----Distance fromnearest'buildir ` ❑ Distance to nearest lot line - g t Remodeling and-/or repairingdescribe)--------------------' ------------_. :} l k, -----------------------------------------------•-------- •---------------------- --••----------------------------•----------------------------------- ------------- -------------------------- ---------------•---------------•---------------------------------------------------------------------------- -------------.--------.--------.------•---------------.......-------------------------- ------•---•---------------------------------------•-•---------------...----•-•---•----•--------•----..------------------•------------------•------ -----------.-------------------------------------.--. ----------------- I hereby certify that I have prepared this application and that the work will be no in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Jo, uin Local H alth istrict. (Signed)--The---]]_t�Y,A---KIG ` ------Sia pt3- --T ank---S ---- ---- ------- ----------------------------------��Contractor) Y•--------_..•--....•---..........-------------••--•-------------•----•----------------- ----- - ------------ ----------(Title)---------------------------------------.......... ------------- (Plot plan, showing size of lot, location of system in relation. wells, buildings, et , can be placed on reverse side). FOR DEPARTMENT USE ONLY C+p �y APPLICATION ACCEPTED BY----- -•---- ------------------------------------------------------ 11-XPI6---. DATE-------- `1 = ------------------- REVIEWEDBY------------------------------------------ - ------------------ --------- ------•- DATE------------------------------------ BUILDINGPERMIT ISSUED--------------------- ------------...------------------------------------------------ -••- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------------------------------•----...-•------------------------------------------•-------------....---------------------....---------- -----------------------------------------------------•--------------------------------------------------- --------------------------------•---------------------------- -----------------•---------------------------- ...... --- .-- ---------------------------- ---------------------------- ., � /may FINAL INSPECTION BY------------- -------•---------- ----------------------..---. Dater I S1-_ r.4�.-. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street ]24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REV1SEti 6-B9 2M 8-61 ATLAS - .j