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t �" ,,� a�: a- -s,�-ems' ✓ Com' " 9, 7 3 FO PF.AMfi APPLICATION FOR SANITATION PERMIT ` Permit No. ___ _ #2739 (Complete in Duplicate) Date issued .27 ?g S� Ap Thiplication is hereby made to the San Joaquin Local Health District for a permit to construct.and install the work herein described. s application is made in compliance with County Ordinance No. 549. 'i _ JOB ADDRESS AND LOCATION-_---._-__9..a6 3. Oro •-- ---••----------•- ---------------------------------- Owner's Name -TrGe_v;.F.--------- 2-14 ----------•---•------- ......................................... Phone.......... ...... 3.. Aelbert Address-------•-------- 9,? ....---••-d Contractor's Name......--.Dgltaj• eptiC-Tank Service : •--•----•----------............................. Phone----:�:7_3 Installation will serve: Residence KI Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of Jiving units: 1_. Number of bedrooms .1_. Number of baths ..___- Lot size .......................... ............ Wafer Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table AD. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan❑ Previous Application Made: Yes � No ❑ New Construction: Yes ® No ❑ TYPE OF.INSTALLATION AND SPECIFICATIONS: �( ,k (No septic tank or cesspool permitted if public sewer is available within 200 feet.) \l Septic Tank: Distance from nearest well..5-Q-1........Distance from • foundation.4 .............Material -7rick� No. of compartments- ---------26e.X _. -_ QisposalFiefd: Distance from nearest ___.._.- . [ - -••_-_--Liquid depth_.5'd3.�.----•-_-Capacity.... oQ----. ----� we)l.....•5_0.j..___.Distance from foundation__-!-_-_-. 1 ..._..Distance to nearest lot line....._,___.... Type o f it lines........ I------------ Type Length of each Iine5.Q.___..__.•.............Width of trench....21.--------.....-•--•- Type of filter material_•_-r-O_Ck....-__..Depth of filter material.....2 ........... Total length__.. •----------------•........... Seepage Pit: Distance to nearest-well_----------_--------__Distance from foundation........_......... .Distance to nearest lot line..... *....... ❑ Number of pits--------------------Lining material..........._..... .Size: Diameter...-•-•-•........---.Depth.. Cesspool: El Distance from nearest well............... ❑ ..Distance from foundation--------.-----------Lining material...__...............____ _ � Size: Qiameter__._.._..... •---•---Distance to nearest lot fine........ .......Depth Liquid Capacity.... - gas Privy: Distance from nearest well.................................................Distance from nearest building ........................... --••-.----•-----•- Remodeling and/or repairing (describe):------InatalllAg:..5.Q-ft•,_- i ��'--- ,�e'k>__c�r lxt..l�.st_�—a--9.�.__t. ---------- l u,er_ti 1__dr2 in.. xert.i��2.. r- �t _kz+r_.X1.1_ d---i.n._._*11h .,t I Hereby certify that I have prepared this application end 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, q I (Signed)- •-••---•-•-- ...De1t-6L.. .ep1.1C..Tank-.ServIce- --------•--•---•-•-.{Owner and/or Contractor) By:.............. ..._per'r'y-j?> rthanD�+rner—AS r. it+Ie)--------....... g (Plot plan, showing sae of lot, location of systa in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY S APPLICATION ACCEPTED BY... .. ------ DATE-� REVIEWED BY ------- DATE.: REVIEWED PERMIT ISSUED.......... y--------•------------------------------------- --------------------•--•------------------------------ -••-----------_---_--•--- DATE........... S� Alter ns or recom ndationsc ....................... ....................... - --..._..... - ------ �r ,--•--•----•-•..............•--•-- -------••----------- ` J ................................................ ---•----•• .... .........----- . ----- -... (/ �� FINAL INSPECTION BY:.. ._.-- ............ •--•---• ----...---• ----•-• Date----------- •-�/--''� . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 300 West Oak Street 132 Sycamore Street 814 North "C" Sheet Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 . � I