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APPLICATION FO►._w,�ANITATION PERMIT Permit No. .Q__ __� ��.. (Complete in Duplicate) 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'LOCATIO!) N 1762-_l2srshal "`.. by--Stk!n'- .Box Co. Owner's.Name-._ Mary Ann_-Kennedy--------------------- �"2 � Phone--: Address-------------------ZJ_6.2___MarSha1,1------------------------------------•--•--------------------------------------------------------------..--------• ----•-------------------------------- Contractor's Name---- ----Deft ----------------------------------------------------------------------------------------------------------•---.._.. Phone 3-'��9--------- Installation will serve: j Residence,® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1-1-Number of bedrooms 9----- Number of baths _1___- Lot size -__59---x___ -14 Water Supply: Public'system JEJ Community system ❑ Private ❑ Depth,to Water-Table ---3--' ft. Character of soil to a depth of 3 feet:' Sand ❑ . Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[N Hardpan I] Previous Application Made: Yes ❑ No [?� New Construction: Yes F] No E❑ r a TYPE OF INSTALLATION AND SPECIFICATIONS: , (No.septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------------------Distance from foundation--------------------Material------------.-----------------.---------.____-__ E,-Xs t Ing No. of compartments---------- ------------------Size-------------•-•----------------Liquid del A--------------------------Capacity-------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line._____________-__ EXDtirig Number of lines-----------------------------------Length of each line------------------------------Width of trench---------------,-----_ -- Type of filter mate'ria ------------------------- of filter material-___- --------Total length_-_-.__.___-___________________________ Seepage Pit: Distance to nearest weI€----no------------Distance from founclation_._Ia---------- Distance to nearest lot line-31---------- \\` e? ® Number of pits-------I------------Lining materialbr_ �*__-__---Size: Diameter_-33 n______.-____.Depth_-_______25'------------------ �f Cesspool:. Distance from nearest well_________ _____Distance from-foundation--------------------Lining material-------------------------------------- ❑ Size:-Diameter------- ------------------ ----------Depth-------------------..-------------------------- -7-----Liquid Capacity----------------------------gals. Privy: - Distance from nearest well---------------------_ ----------_----------Distance from nearest building-------------------------_-___.____-_____. ❑ Distance to nearest'lot-lin e------------ ----------- ------- Remodeling and/or repairing (describe):___....--addiri BeCpB e}_�i# t0_ exi�ltirio rsptic tank 8yete I ,i ------------- -- ------------------------------------ --------------------------- ----- ---------------- - ---- --a-•------ 14 ---------------------------------------------------------------------------------------------•---------------------------------------------•---------------------------•------------------•-------------------------- 1 ."I ' ---=---------------------------------- ---------------------•-----------------------------------------------------------•------------------------------ 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, , (Signed) DP.1t1%----•-------------------------------=------- --- ------------------------------------------------------ -- ---------------- -------(Owner and/or Contractor) [Tltlel----Gena M . By:_ P errY.-.:WBrthr-.n------------------------------------------------------------------ - --------------- ------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 4} 4" ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---1-------------- ------- --------------------------------------------------- DATE---f______••----.--..----_ REVIEWEDBY------ ----------------------- --------- ------- --- --- --------------------- ------ DATE--- - BUILDINGPERMIT ISSUED-------------- ------ ----- --- ----- ------------------------------------ ----------------- DATE � •-----------------•- Alterations and/or recommendations---------------- ---- _ ---•----------------- -- -- ----•------------------- - ' - --------•----------------------------------------•--------------------•- ----------------------------------------------------- ---- ----- --- - ----- --- ---------------------•---------- ------------ ____________________________________________________!----------------------------------------.___.___----k_______________-_.-_-_-.._ ._______-____.__---_--__.---._.________________-_______.-_______-__________._____.__. ---------------------------------------_-----------------------_---------------------_----------------------------- --------------------.---__-__.--.________._________-_____._____.__________._______________._____ - Date ..../1 -- -�---- n ---- ---- -----------------•---- FINAL INSPECTION BY::--z_._.__.. _ -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 1 132 Sycamore St1 reet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 1 - Es--9-2M 145446 ATWUUD 12-54