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j)-6 I 145 3 APPLICATION FOR SANITATION PERMIT Permit No. ----10_%--�•-Z .rll (Complete in Duplicate) p�o�rf� E Date Issued ---•----"""--- "_--_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-----------------2256--M--r_ck----------------------------------------------- i Owner's Name_Mr*__DEIN._-CQ0_�m ----------. Phone------------------------------------ - Address--- ....MC---FaAAnd------------ -------------------- -------------------------:------=-------------------------- 1 Contractor`s Name----IKEt3--SEPTIC--TRK--SFiRVICE----------------------------------------------------------------------------- Phon4j".4---ab.527,&----------- Installation will serve: Residence f] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -__ Number of bedrooms Number.of baths -1--- Lot size ___1Q8_Xt--XWft________________________ Water Supply: Public system ❑ Community system ❑ Private.0 Depth to Wafter Table _______ ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeo Hardpan ❑ Previous Application Made: Yes ❑ No ] New Construction: Yes R] No E] FHA/VA: Yes ❑ No El 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-------------------___________________.________- ❑ No. of compartments------ ------------------Size------------------------ -- ---Liquid depth--------------- -----------Capacity_-.-------------------- Disposal Field: Distance from nea�nrest well_4 ft_____-Distance from foundation_1flf�_____.___Distance to nearest I + Iine_-_2aft---- :E] Number of lines__ __________ Length of each line____c_�__f�._-_____-_______.Width of trench-._._____�°___...____-----.- - Ic ---- - N Type of filter material---------- k__________Depth of filter material----1$".__._Total length_30,ft________-._-----____________._ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line----.---______.__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth----------------------------___-- Cesspool: Distance from nearest well-----------------Distance from foundation_=----------------.Lining material-------------------------- ElSize: Diameter------------------------ Depth------------------------------------ ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building____________._____________----_______._. ❑.. Distance to nearest lot line-------`- _ *--------------- -----=----------- ------------------------------------------------------------- Remodeling and/or repairing (describe):-_—-- ------Additional ---ra1L1$ C--------------------------------- ------------------- S, -------------------------------------------------------------------- ----------------- _-._______________________________________._______________.___.__________________________..__._ . i _ �..� .. c,;7 1 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. IKES SE ---I --.'�ANK_"SERVIC�+---------------------------------------- ------------------------------------------(Owner and/or Contractor) (Signed) - -- ------ t = ---------------------"----------------- -----------------------------------{Title)------ - ------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEP TMENT USE ONLY APPLICATION ACCEPTED BY -- - - - - ------ ------- ------ DATE------- � ------------------------ REVIEWED - =REVIEWED BY---------------------------------------------- -------------------------------+ -•-------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations----------------------------------- ----------------------------------------------------------------------------------•-- ----------------•------------------ ----------------------------------------------7----- ----------------------------------------------------------------•----••---•--- ----------------------------------------------- --------------- --- �d�------- FINAL INSPECTION BY.----- ----------------- - ------------------ - Date. - 13 - ,S SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1.57 F.P.CO.