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FOR OFFICE - E. A; M, , , APPLICATION FOR SANITATION PERMIT Permit No. ..._ ___ .. . (Complete in Duplicate) Date issued:. ��y/ f ___ -___-_'__.__- This Permit'Ex ires 1 Year From Date Issued _____._.__ �e Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. l This application is made in to with County Ordinance No. 549. JOB ADDRESS AND LOCATION_-------- 53--�--East -Dana -----------------------------=--------------------------------------•--------------------------- Owner's .Name---_--__ _ Ho. 3wo439 end-_Mrl....Ed.. R• Berry------------------------------------------ Phon -------- Fran & Tre_vra--Banda Address------ Portland, Oregon overseers of--prop. Contractor's Name--------.D_t' iA �C?_i�.CC 'si __s_� V3 Cha ---------------------- •---------... Phone Installation will serve: Residence [3t Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑, Other E] Number of living units: ---.2 Number of bedrooms __3____ Number of baths --2__ Lot size J0__ x L00 --------------_-_-_--------- Water Supply: PubliJsystem [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 [-I Previous Application Made: {If yes,date--------------------I No ® Now Construction: Yes:K] No ❑ FHA/VA: Yes [I No:] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I. Septic Tank: Distance from nearest well-------------___'Distance from foundation-------------------Material------:-_____________-_--____________-____..... k I3xisting No. of compartments------------------ ------Size-_--------------------------=---Liquid depth--•--..-------------------Capacity----------------------- } Disposal Field: Distance from nearest well------------------Distance from foundation-------------------Distance to nearest lot line___............... [§Xisting Number of lines-----------------------------------Length of each line------------------------•---_Width of french-------------------------.---------- Type of filter material-------------------------Depth of filter material----------------------- otal length--------------.--------------------------- V I � . i - Seepage Pit: Distance to nearest well---------4q-------Distance from foundation______�-©t.___.Disfpce to nearest 1pt line___��______-_ Ix Number of pits-----------I---------Lining material.r0gk---------Size: Diameter------3-b-----•.-----Deptl?_�_____ ax'------------ i Cesspool: Distance from nearest well-----------------Distance from foundation--------------;____.Lining material-----.-______________________._---__. ❑ Size: Diameter-------- ------Depth----------- ------ ---------------------------------Liquid Capacity_--------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-----------------_-----------------_------ ❑ —. 'Distance to nearest lot line -.------------------ -- --------------------------------------------•---------•----- •------------------------------------ ---- ,. - Addin Filter—Bed system Remodeling and/or repairing (describe: *-------------------.... ------------------ ---------------•--•--------•------------------------------------------------------- - --------------------------- -------- --------------------•-•---------------------------_._ ------------•-• ------------.-----------•------------------------------------------------------------------------------- I hereby certify that I,have prepared this application and'that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------Del,_t_a--- _ep- ic---T_an1X_.A9eY:y1ge.*---I-nC-,------------ ------------------------------------------(Owner and/or Contractor) By:--------------P ei r --Q_..--W rthan--•------------------------------------------------ - {Title) Gen. Mgr' (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 fx * c�4 't - = RATE + - - --------------- REVIEWEDBY----------=R------------------------------ -------------------------------------------------------------------`------------- DATE___--------•-------•----•--•-----------------•-------------- BUI LDI NG PERMIT ISSUED---------- --- -----=------------------------------------------------------------------- ------ DATE---------------------------------------------------- Alterations and/or recommendi#ions:^ -`----------- w-� _ _ ==---•-••-----=------------------------------------•--_--------------------•-------------------------------- -------------------------- --------- -------------------------------------------------------------------------------------------------------- o ----- FINAL INSPECTION€' BYE_ --- ------ --- ----------- Date----------------- � / SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street , Stockton,California Lodi,California Manteca,California Tracy,California f E9-9 REVISED 8-59 G.P.0 O.2M 6.60 Y