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FOR OFFICE USE: _ / Art-LIGATION FOR SANITATION PERh4f Permit No. _.Ilr Z/-- -- ---------------------- ------------------- (Complete in Duplicate) �a __________________ 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. 549. JOB ADDRESS AND LOCATION---Twin---Oak..Mehile----Park.._4823...S_Q_ 99_ Lodi.,Calif -_ I hia4y----------------------------•---•---------------- Owner's Name_____ .A•Sandeen & R.J.Perata Phone------------------------------------ Address----------------- 4823--Sguth---99--Hiway,-... ------------------------------------------------------------------------------------ ----------- Erni e t s Septic Tank---S_ r_yiPhone----------------------------------- Contractor ----------------- _c_e--••----------------------•--------------.-.--- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ® Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths ---------Lot size ------.L jq_ ," Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table " ft. ? Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [j Clay Loam L] Clay] Adobe❑ Hardpan Previous Application Made: (If yes,date..............__._.) Nom❑ New Construction: Yes [j No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: #� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t [I Septic Tank: Distance from nearest well________�Q___Distance�e f{om fofndatton__ Q_____-_-_._ Mater�al----_COY]Cx- - --------------------_. . [I No. of compartments__---3_____-____._____Size-Ai__6---xl$__x.�__Llquid depth--------4__-------------Capacity_211-QQgal. Disposal Fie#d: Distance from nearest well- - -501----Distance from foundation__1Qt----------Distance to nearest ]of line__________ Number of lines--------P--------------------------Length of each line.-----10-0-1-------------Width of trench----_-2-4!-.--------- Type of filter material _-__-T O_Ck-------Depth of filter material----.18............Total length----------2QQ__________________--._ .%I', Seepage Pit: Distance to nearest well._.__�.�}Q�___--Distance from foundation_____-1Q.t.___.Distance to nearest lot line___5 .________ �j Number of pifs.....2--------------Lining material------rA-Ck-----Size: Diameter-----4B_'4B_'-........Depth---25.�-----.------------- Cesspool: Distance from nearest well-----------------Distance from foundation._.-----------------Lining material-------------------------------------- 0 Size. Diameter------------------------- -Depth---------- -----------------------------------------Liquid Capacity- --------------------------gals.w f Privy: Distance from nearest well------------------------------------------------- from nearest building-___-___--.______________________.__-----. v\ ❑ Distance to ----------------- ----- nearest.lot line-------------------------------------------- - ---------------------•------------------------------------------------ - \n"`�� 1 n Remodeling and/or repairing (describe):-------------Wash house - -- X ------------------------------------------------------------------------•--------=----_------------------------------------------------------------------------------------------------------------------------------ -----------------------------------------------------------------------•--•-------------------------------•----------------------------------------------------------------------------------------------------------------- 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)---__ '�' _ tn---' _P_pt e----T k._Se_r_vJ_.c_e------------ ------- ---------------------------------------------------------(='XM/or Contractor) BY-----�' -------- (Title} ---- --------- - - - - - - -------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------------ ---------------------•----------------------- DATE...... G3----------------------------------- REVIEWEDBY------------------------------------------- - ------------ ------------------------------------------------------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------3------------------------------------ DATE------------------------ - - --------------------------------- Alterationsand/or recommendations---------------------------------------- ----------------------------------------- -•------------------•------------------------------------------------- ----------------------------------------------------------------------------------- ------------ -------- ------ -------------------------•----------------------------- -------------•--------------------------------------- ---------------------------------------------------------------- -- ------ - --------------------------------------------------------- ----------------------------------------------------- --•------------------- FINAL INSPECTION BY: .-- .. - _ --- ------------------- Date----r�.- 9- C3 - _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ii ES 9 REVISED 8-59 3M 3-'63 F.P.CD. }