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"1 APPLICATION FOR SANITATION PERMIT Permit No. _Aq......_SS__-. (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. 4 JOB ADDRESS AND LOCATION--------835-_Flowe_r----------------------------------•------------------------------------------------------------------------------------------------ Owner's Name----H3Krry__B_Q armas-te :'----------------------•---•-------------------------------- -------------------------------------------- Phone-------------- --------------------- Address-------------$3S__Flava-r-----Storkt M--------------------------------------------------------------------------------------------------------- ----•-------------------------- Contractor's Name------ KE-IS.-SEPTIC__jAK_K_.3ERVjCE--------------------------------------------------------------------------- Phone.---_-----M_-4-527la_ Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel,❑ Other ❑ Number of living units: __ -__ Number of bedrooms _____2_ Number of baths ___1__ Lot size ----'_-5_-f-ty___x-----16Q.ft.,___-____________ Water Supply: Public system ❑ Community system ❑ Privateer Depth to Water Table _-,gyp_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 31 Hardpan ❑ Previous Application Made: Yes M N�New Construction: YesXN No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well-----591------Distance from foundation____-.Q----------Material ___Re_d._IlrToacL_______________________ No. of compartment s----2---------- Size ..-------3,x5x-R---:_.Liqul+f`id depth_----------- t-------Capacity-,0D--gal----- 00 Disposal Field: Distance from nearest wel ._Distance from found tion___:la-1---------Distance to nearest lot line__5-!----------- ® Number of lines____2________---_'---------------Length of each line_9$__---an`_z2_____..Width of french-------4-in--------------- Sum Type of filter material_.------Rock___ .........Depth of filter material__-g__7A.___._Total length._- Q___f�.,_.__________-______.-__-- ' : Distance to near(st well----99-ft _.___Distance from foundation___ Q__ft_s__.Distance to nearest lot line---- 15fta_ El Number of pits----------------------Lining material---Rock----------Size: Diameter_41,X6r-----------Depth-------6.t---------------------- Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material__-----_____-_._________._____-______ ❑ Size: Diameter------------------------- -----------Depth----------------------------------------------------Liquid Capacity- --------------------------gals. 10 Privy: Distance from nearest well-------------------------------------------------Distance from nearest builcling----------------------------------------- 1 ❑ Distance to nearest lot line-s------- ------------------------------- ------------------------------------------ ---------------------------- Remodeling and/or repairing (describe):-------------------------------------- ------------------------------------------ •-------- ------------------------------------------------- ----------------------------- --------------------------------------- ----------------------------------------------------------------------------------------------------- ------------------------ -NhJ1 P --------Jew------cpKle- _S r1tt--------- -------------------•-------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- ------ 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. Si ned S SEPTIC T 1K -- VICE Owner and/or Contractor (Signed)---- ----- - ( ) By:........... = -� = = ..._(Title)-----------0 r------------------------ -- (Piot plan, showing size of Of, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- ------ --- ---------------------------------------- DATE------------r-. b REVIEWEDBY--------------- -------------------------------------- ----- ---- - --- ----------------------------------------------- DATES ------ --- BUILDING PERMIT ISSUED---------------- - -- - - = -------------------------------- --------- DATE------------------------------ - Alterations and/or recommendations:---------------"-- ------- -------------------------------------------------------- ----------------------------•-----------------•------------- ---------------------------------------------------------------------------------,-----------------------------------------------------------------------------------•------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -----------------------------------•----------------- ---------•------- -------------------------------------------------------------------------------------------------------------------------------------- --------------- FINAL INSPECTION BY:.. Date ar - ----- ---- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+ree+ 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO.