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E: OR OFFICE US . -----��- Permit No. . �-.... ------------------------- - -� � !APPLICATION FOR' SANITATION PERMIT --•••---••- �' (Complete in Duplicate) Date issued 7�� ,�G•�" X, .. �n This Permit Expires 1 Year From 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 Count Ordinance,No. 549. a; hir�gton & Agree. S JOB ADDRESS AND LOCATION......:..... . - -- B .�.a._-WalkerST PhoneT4 42 5.44- car ez� e Address----------------------------- �3 _. ,� Adrienne---------------- -----------------------------------------------•--------_--------•-��---• Q.... n -•-38- 41 Contractor's Name....T1 e----D�--c�S.-11GHH' rU_ _ptic__.Tank__S-er.vi_-ce------------••---------------------- Phone--- • Installation will serve: Residence ❑ par ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other EX* Number of living units: Q:-.°. Number of bedrooms .----P Number of baths -------- Lot size .--13Q1.--X12Q-•...........-................. Water Supply: Public S'ystem.Xr, Community system [:] Private [jDepth to Water Table -_(D ft. .� y Character of soil to a depth of 3 feet: Sand ❑ Gravel,❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IU Hardpan (,A i Previous Application Made: (lf yes,date--------------------) No [ New Construction: Yes ❑ No FHA/VA: Yes ❑ No G . UL 4F TYPE OF 1NSTALLATION,ANQ SPECIFICATIONS: (No septic tank or cesspool pe mined if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_XPAj®....Distance sfrom foundation-----2 th-_5$I�al--�C—pp, $QQ-- .... a- { No.'of compartments-------a----__------..-Size_56!_x3_6 q p. tt An Disposal Field: Distance from nearest well- QYIe-.._Dista nX Som Pu Ation--a..5#--.-••---.Distance to nearest lot line....... ........ t t i st i Number of lines----3----------------------------Length of each line----ZiS---4�-----.Width of trench.--- 2- --••---._.. 11 ------Total length-------•---1QQr-.-_-------------- Type of filter..matenal ePtC__Rk_Depth of filter materiae--.___-- -- Seepage Pit: Distance to eares2well--- ®----:---Distance from foundation_-_....15--_-Dist ,nce to nearest lot line----_-- ax Number of-pits----------------------Lining material----RPGk_------Size: Diameter.-----� _--_-----•.Depth-------._.25..-...-•------• 1 Cesspool: Distance from nearest well----- ----------Distance from foundation---.--------__---.Lining material------.-----------_.---_------__---. k -------Li uid Ca aci gals. ❑ Size!: Diameter--�----------------------------------Depth-------------------•-------•---------------- q P tY----•----•--•-------•--•--•- 1 I. -�-Distance from nearest buildin r Privy: Distance from nearest well--�---=------- - --------�-----•--�----- -- 9- ••---------•---------•--------------•-- ❑ Distance to nearest lot line------------•----------- ---•--•---•--------------------------------- ------------- Remodeling and/or repairing (describe)------*Drive------Sn.-Ca£e,-...-.--- ldin&..Xavbd---�.I�1..�3---tat.+----------------- •--•.........._.........------------------------------------------------------------------ --------------------------------•--------•-------_--------- I = ---•--- --•-------------------------------- -------------------- '_ -t i -----------------------------------------------------------•----------------••-----------•-------------------- t I hereby certify +hat 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. Thi DAY & NI( � "S8�?#r _.•`' itk--SE3ryTbdings, ------------------------------------- (Signed) ( XCon#rector) ------ = 5 I (r+lel---------------------------------------------- ---------------- By: ------------------------------------------------->------ ------------------(Plot plan, showing size of lot, location of system in rela+ion to wetc., an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ---- ------ - -- - --- ----------•---------- ----------------- DATE-... _".. --- --�� `---------- ' REVIEWED BY--..... DATE 1 -------••---------. :: ----- BUILDING PERMIT ISSUED-------------•-------------- --------------------------------- ---• ------------------•-------------------. DATE----------------------------------------- ------------------- Alterations and/or recommend ons:------..------..-`----------- -------------------•-- _-- - ------------ - ---- - - .... - -_ -� .� - ..-- FINAL INSPECTION BY:..J Date----- -r- ---- ....._----- --....-. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak-Srrow 124 Sycamore Street 205 West 9th Street Stocktdn,California Lodi,California Manteca,California Tracy,California 964 REVISED 0•99 RM 3-61 ATLAS t