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APPLICATION FOR SANITATION PERMIT Permit No. �_ ----- � � f (Complete in Duplicate) /�S- � 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. i JOB ADDRESS AND LOCATION_-----------Rt-...... ---A.ahl y--La..�.e__fl-Af---Of---99---Hi7_7da-y----t0.--lat- t . which is Cole ➢rive `Gnd end house on Soy.-done---4-_5�37---------------- 1 Owners Name----F 1-1ta-u-A-d-11a------------- EAddress----------a3Et!e-------------- ----------------------------------------------------------------------------------------------------------------------------------- Phone------_'z-39 Contractor's Name----------- --------•----••-------------------------- Installation will serve: Residence 50 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____1_ Number of bedrooms ------2Number of baths ____j_ Lot size __ _________________________________ Water Supply: Public system El Community system El Private ® Depth to Water Table ________��XZDQft. Character.of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan s Previous Application Made: Yes ❑ No [3 New Construction-. Yes E] No ❑ 3 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___5Q_` _Distance from foundation------6_........._.Material----C_ 1T?Crit-brial ---------- No. of compartments------------2------------Size-----6.'-x4'_x4------Liquid depth---5' `-� Capacity near i Disposal Field: Number ofolines earest well-------- Distance of rom e each line_ation--------------------_ Widthcofttrench est lot line----------------- ❑ Type of filter material--------_--------------Depth of filter material------------------- Total len gth_----------•------------------------------ �.t __.Distance to nearest lot I e_______rr � Seepage Pit: � Distance to nearest well____�5t_________,Distance from foundation--.6-1 � �------- E] Number of pats----------�,---------Lining material___ Size: Diameter-----1i�Tj-----------Depth-----top-------------- ---------- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material_-____________________-____________-. ❑ Size: Diameter---------------:----------------------Depth--------------- ------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well------------------------------------------------- Distance from nearest building----------------------------------- Distanceto nearest lot line-------------------- --- ------------------------------------------------------------------------------- }�* Remodeling and/or repairing (describe):-------I\le-L EY-l..P-na --------------------------------------- ---------------- ----------------------•-----------•------------ R _ _ _____________________________«.-------------------------------- ---------------------------- -- � -------- -------•---------------------------- ----- ---_ -----------------------------_---------- ____________• ------------------------------------ __-_______-•_________••-_•__- ______-_________-___ - hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r -----------------------------------------------------------------------(Owner and/or Contractor) (Signed)--------------=----12�'.i.t_��--------------�------------------.------ ' ---------------(Title)-----OA-mer_iJ'y r'--•------------------------------- (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY DATE = - ---------------------------------------------------- ---------------- REVIEWED BY---------------------------------- DATE_, BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------- Alterations and/or recommendations--------------------------- ---------------------------------------------------------------------------•-•-------.-------------------------._.. I -----•--------•---------------------------------•----•-------••----------------------------------------------------- FINAL INSPECTION BY: ---------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Stree+ Stockton, California Lodi, California Manteca, California Tracy, California F- ES-9-2M 8-51 Revised W-2100