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tOKOFFICE U5E: OT- 47 13 ._--.._.-_._____-.___.-_-._.__---_________________ APPLICATION FOR SANITATION PERMIT Permit No. __f.... . - --------------------------------------------• (Complete in Duplicate} Date Issued .... -------------------------------------------------------- This Permit Ex ires`1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a .permit to construct and instal the work herein descri ed. This application is made in compliance with County Ordinance No,.549 Wt end of SCh001 •�- JOB ADDRESS AND LOCATION-----HalmarHei�hs_•.- SO ____of_____I St_ Lathrop Ca_ _ f__ n 1 +---�. T?� �, _ ._.. Owner's Name-----Fh ,11_1P_S""- Qn CQ� --•""" � � .._..----�------------------- Phone..W27n0715------- Address--- ------ Address._ - 861+ W, St, "e "-... an---•--------------------------------•-•-------------•- The DAY & NIGHTdpContractor's Nam .._ .- -- --- -------------------- Phone...H9...6!n35I1------ i Installation will serve: Residence XX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..__ Number of bedrooms'-,3--- Number of baths ---I- Lot size ---1QQ1----SZ0O.1............................• 1 Water Supply: Public systemU Community system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loamj,$ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (1f'yes,dote--------------_-----) No ❑ New Construction: Yes XK 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 _from nearest well_NonG Dista ce fro fo ndation_____.._7-0 __.Material______CC___Br Brick Septic Tan Distance " `""'N of comp rfinents_-_:---2:�_:""'"----s E1: a-r=x �� L'iquid cte 3th $tf:_ Capacity--- Disposal Field: Distance from nearest well___,None-Distance from foundation........lfl1�--- D'�Lance to nearest lot line.......5!..... Number ofdines_______2___________________.__.Length of each line...`�Jr._1___Sf�EE__—VF#WiZlFh of trench----2Y.1.___.___------------� �r Type of filter material...P.._...Rk.._.Depth of filter material_.__.1�•'__:______.__Total length.--- _...l� t S Z� T R.iO` 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------------------------------------- Size: Diameter---------=--------------------------Depth----------------------_--------------------------Lijuid Capacity------- -----------....gals. Privy: Distance from nearest well------------------ ___________________________Distance from nearest building--------------------------------- 1 ❑ Distance to nearest lot line-------------------- --� �j Remodeling and/or repairing (describe) -es--�-4 --------------•-----...---•---.._.....4RO.DF-_...v9 .�- ft Q_ . 1� -� �.-•_ -�-----R.----S----=-/---N�--------------V ----F-----.----•:--:-:N--•-.-----••--.--.--C__-, ---Q" -•• �--•T---R'-•:"t._�-.-.•----•-- -----.. ---------------SMD-----N�....WOtIND-----C #FrK._. 7. Q•A ,,rs -_ r. I 8 --•---•---------------------------------•------•--------- ----------• ---------------- ---------------------------------------------T.� . _._. I hereby certify that 14have 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 ocal ealth District. The DAY &' NTGHT-Se _tic -Tank�Seivic 5i ned -------------------------------� ------------ - --------------•---- -------- Contractor ( 9 )----- ) t By:....................................------------------------------------------------------------------- .-- --- - tile)--------nnnn ---- �-- -- ' (Plot plan, showing size of lot, location of system in relation to wells, Idings, etc.,. ,n be placed on reverse side). FOR DEPARTMENT LAE ONLY APPLICATION ACCEPTED BY------- --------------------------------------------------------- /___ DATE.--------qv. � -A- �=---="•-•- REVIEWED Y-------------- ----------------------- - --'"BUILDING PERMIT ISSUED. ......... .......... ----------................ -•---....r.---.... AFFerat;ons and/or recommendations----------------------------------------------------------------- -__---__-__________ ___________________________________________________________________"-.__._ -•.......................----.......----------•-..........------------------. kr ------------------------------------------------------------------------------------------------•--...------....".....----------•--------------- i ------------------------------------ ................ ---- --- ------------------ ----- ------ -- --- --------------------------r-------------------------------------------------------------1.......----------.._. i FINAL INSP Date.------�57- -G�-=---00�Y--- •------•--• ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamor*Street 205 West 9th street Stockton,California Loclir California Manteca,California Tracy,California E6 9 REVISED 0.59 aM 5-61 Ar LAS -