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r � y APPLICATION FOR SANITATION PERMIT Permit No. . _-r1r'^S (Complete in Duplicate) Date Issued -5-Y 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-------53-02---E_=---Dana------------------------------------------------------------------------------------------------------------------------- Owner's Name------4-----Am].aZLEll_Amialau—Chew--------------------------------------------------- ------------------------------ Phone-----5-2-052--------------- Address -------------- Address---------------D_=e-----------------------------------=--------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name---------D-e-Zt�--------------------------------------------------------------------------------------------------------------------- Phone-----3-3955------------- Installation will serve: Residences Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:Z_____ Number of bedrooms __2'__ Number of baths 1_____ Lot size __6_Q__'X150----------------------------------.__ Water Supply: Public system [X Community system ❑ Private ❑ Depth to Water Table -_45- ft. Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ ' Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No a TYPE OF INSTALLATION AND SPECIFICATIONS: W (No septic tank or cesspool permitted if public sewer is available within 200 feet.) O ( Septic Tank: Distance from nearest well----------------Distance from foundation-------------------Material_-______-_______________________________________- EX13TINT G No. of compartments--------------------------Size--------------------------------Liquid depth----------------------- --Capacity----------------------- P Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line____________-____ 1 EX1BI ING Number of lines-----------------------------------Length of each line N-_____-----_-____--_------.Width of trench----------------------------------- Type of filter maternal------------- Depth of filter material-------------------.---Total length------------------------------------------ rSeepage Pit: Distance to nearest well_____ .__751.___Distance from foundation----- G_.........Distance to nearest lot line------ -------- [� Number of pits------1_._____•---i l i�' g material__b3 3 4' ------Size: Diameter----42�°-------_---Depth-- (��-------------------- Cesspool. Distance from nearest well-----------------Distance from foundation----.------:--------Lining material____________________________________ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid-Capacity------------- ----------------gals. E _ F 1 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____________________________-__-_-_____. ❑ Distance to nearest lot I;ne-----------------------------------------------------------------------------------------------------------------------• -------------------- Remodeling and/or repairing (describe):------Ins-tallil1s__new---var-t_lC_21__SIra i_n--£3?7,.I.u_-_thr_o_u`,.h_.n1SI__________ ?'a. - -- ----------------•--------------------------•--------------------------------•------------- ---------------•-------------------------------------------------------------------•----------- 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. (Signed) -DP,_L 3__________________ --_Owner and/or Contractor By--------------------------------- -----------------.-------------------------(Title)--------------- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE_ _ REVIEWEDBY---------------------------- - --- -- ' ------------------------------------------------------------------------------ DATE------ -------------------- BUILDING PERMIT ISSUED-----------------------------------------------------------•----------------------------------------- DATE---. Alterations and/or recommendations--------------------------------------------------------------------------------------------------------------- ----------------=------------------------- ----------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- -- �. -----------------........------------------------------------------------------------------------------------ ------------------------------------------------------------•------...------------------ ----------------------- -- ---•------------------- -------------------- ---•--------•----------------------------- ------------------ ------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:--//`��/ ------------------------------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100