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��1„yy1 FO,APPLICATION . SANITATION PERMIT Permit No. ___ ------------- * (Complete in Duplicate) Date Issued _--Jf ' s 1 F Application s hereby made to the San Joaquin Local Health District for a permit to construct and instal;the work herein described. i This application is made in compliance with County Ordinance No. 549. "" fast --------------- JOB ide JOB ADDRESS A D LLOCATION_2003�ftl.---- -t----------- iveeak__Rd.----° � H ---Way - - --- - Owner's Name. SaiA. EZIBAa_. tigu�. - Phone Ho. 5-3io7 Address.-•-------- 4 9$-•-�,. Filbert: �t.-2n._�_-.----------•----------------------------------•----------------- --------•- ----------- k � _ry _ Inc3--?27----- Contractor s Name----T�s�._t-&__3��2-�1-0------�•------- �-y---- G-- -i--- - ------------------------------------------------- Installation will serve: Residence [I' Apartment House ❑ Commercial ❑ Trailer.Court ❑ Motel ❑ Other ❑ Number of living units: __1--- Number of bedrooms __2_._ Number of baths �_____ Lot size ------'�SOrB ------- -------•--.---- Water Supply: Public system ❑ •Commur'ity system ❑ Private [�: Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ ❑ Previous Application Made: Yes El No Ej 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.) �. c. cement—brick Septic Tank: Distance from nearest well----.�2Q _k_Distance from foundation_-PP1-g---.MateiaL__.__________-____.-_____ --•----- P V No. of compartments �- Size------ '�_x -------------Liquid depth-<: -�3- Capacity •--- -- Disposal Field: Distance from nearest well----SD�__-._.Distance from foundation__FRR0 ---Distance to nearest lo� line___a�Pl-- Number of lines------------`1-------------------Length of each line--------- ��-------=-----Width of trench___-__ 07---_------------------- � n 0 Type of filter material------r-QC1�_------De th of filter material--V- ------------Total length------------------------------------------ 100'' ` p emgl Seepage Pit: Distance to nearest well___________ _______Dista.nce from foundation_______.____..__._-.D�an Ice to nearest lot line-_--+��--8 -� Number of pits_-----�.------- ----Lining material __ '4C1 ------Size: Diameter--------- -------------Depth_. -.- - _--------------------- w { Cesspool: Distance from nearest well_________------__Distance from foundation_______________.__.Lining material-------------------------------------- Cesspool: ____-------..____.________- -__ __ • ❑ --------------------------------Depth__---=------------------------------- Liquid Capacity gals. Size: Diameter_________ ` ______Distance from nearest building Privy: Distance from nearest well ----------- ----- ---- - ------- - ----------------------------------- --- Distance. -� ❑ Distance to nearest lot lire------------------- -------------------- ----------------------------------------------------------------------------- -----•------------- Remodeling and/or repairing (describe)---------------114O-w---OY tQm Uxltil ne�__houae---j-e---built------------------------=-- - -------------------------------------------------- ------ ---------- ----- ------ ---- ----------- ----------------------------------•------------------------------------- --- --- -----------------------•-------------------•--------------------------- ! 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. __ ��. $-_e-Ptie__T&t1k-_g@Y'4 CLQ--- -----------------------------------------------------------(Ownerand/or Contractor) (Signed) ESB a.-(Title)-- ------n------- "ffr`-------------- ---------------- U - ----- (Plot plan, showing size of lot, locations of system in to wells, buildings, can ke placed.o�-reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY----- ------- ------------ DATE------------------ --� ----------------------•---- -- - -------------- ------------------------------------------------ - .. -- --- - - -------- ----- ------------------------------ DATE---------------4"---------------_--------•------------ REVIEWEDBY-------------------------- -----------t- --�------ - BUILDINGPERMIT ISSUED------------------------------------ ----------------------------------------------------------- DATE---------- Alterations and/or recommendations:--------------------- ----------------------------------------------•--------•--------•-------------• ----------------------- / --------------------------------------------------------- --------- l ---------------------- ------------------------------------------ -------------------------------------------------- FINAL INSPECTION BY:--- _ I-e--Zltjo------- ----------------" Date �'" ® _`-�7 ---------------- "' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 3o0 West Oak Street r" Y" 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21+4 Revises 1-57 F.P.CO.