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FOC JC USE: ---------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. ... 6_ ------------------------- ------------------------------ (Complete in Duplicate) -------- --------------------- 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..._........143-1 W1--1118-MB Street Owner's Name-------------Xr•.... W.....`.I'xlT?lQty-x......-----•-••---------------------------------...-----------------------•----- Phone.FHO....4-4225...... Address---------------- ---------451 K��11am St...� - --------------------------------•--•............................ .........-...... Contractor's Name------p43.t-$-- fipfC_-T82k SeVCe�- II1C:� phone_HO� _, �.5. . .....-_---- - Installation will serve: Residence [3 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1---- Number of bedrooms _ ---- Number of baths .-1_-_ Lot size X100 Water Supply: Public system ® Community system ❑ Private ❑ Depth To Water Table -45- it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobes][ Hardpan ❑ Previous Application Made: (If yes,date....................) No ® New Construction: Yes E] No ❑ FHA/VA: Yes ❑ No 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-------_-----..-..-.-------_.._----------__.----- EMisting No. of compartments--------------------._.-Size-------------••----------------Liquid depth------ -------------------Capacity....................... . Disposal Field: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line......_..--.____. Fmisting Number of lines-----------------------------------Length of each line--------------------..........Width of french------------•------..-----------•• (�J Type of filter material----------------------__Depth of filter material-----------------------Total length------------------------------------------ .� Seepage Pit:' Distance to nearest well--------nQ--------Distance from foundation--_( ...........Distance to nearest lot line_5-t.......-.. ® Number of pits--------1-----------Lining material----rQGk-------Size: Diameter_...3.311----------Depth_2.5.'__-mom•--•------- (� i Cesspool: Distance from nearest well-----------------Distance from foundation.-.----.- .------.Lining material..--..-------.-.-_--.---.---._....... ❑ Size. Diameter--------- ----------------------------Depth----- -•---------------------------------------- •-Liquid Capacity -•-•-•-•-------•--•--•---.4als. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.-------_-.-.-------_-._....---.--.-.----. ❑ Distance to nearest lot line-•'------------------_----------------------------••-------•--•-------- Remodelin9 and/or repairing (describe):---_.9_40149--_33"x25tFilter—Bed to existing 8 stem .-----------------------------------------------••--------------- ------ --------- ------------------- -------------------------------- I --•-------------------•---------------•--•-•--•-----------•--•------------•-----`---•----------------•--•-••-------------------•----•-----------------------••--------------------------------------------------------- -------------------------------------------------...-----•--------••--------------------•----------------•-•--------------•-------------••--------••--------- - ------------------- hereby certify that I have prepared this application and that the work will be done '"'accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local-Health Dis . �3e�.t-&-- tic Tank -Servi,c n-::f, �.- (Signed) ----------- - ---- _ --------------- -----------(Owner and/or Contractor) BY: ------ kert-ry--Q..__.War�hat-� G�'':_.-.: ? _�' isle) Gin-•- Mgr' (Piot plan, showing size of lot, location.of system�I r on to , buildi gs, etc., can be placed on reverse side}. ' FO DEPARTMENT USE ONLY APPLICATION ACCEPTED . � ------ DATE.......f ..- . REVIEWED BY '-----------------•--- DATE..-•--------------- --- -7 -BUILDING PERMIT ISSUED------------------ TE.... � Alterations and/,or r recommendations:- - -- - . - st �P{z�..- jsz rptE - - - P-...... -/ .,� - -rr.�l�_a�.._1i � r� ��•�-•-- -----� E�7�".�--�atc'.---�-�- -�--- 076. . -�-�---��' -� --�+ ----1-. . -�. -- ' _j - -xac.rte. 4-FINALINSPEC ION BY:. Date p. ( y ` . aa �a-Y•E �es�d ` £rl �4�czyt � SAy AQUI5tOC.✓ H TH SS'TRICT 130 South American Street 300 Wsl Oa �ro•1 / '' V Ycamore-51r•e�� 405 West grit 51r.•t 4i Stockton,California ;Lodi,California Manteca,California Tracy,California E9 9 REVISEt) B-59 2M 5-62 ATLAS L .