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APPLICATION FOR SANITATION PERMIT Permit No. .__�__J_.___y_ (Complete in Duplicate) 7/�� Date Issued _____ _�_-_ __ ..s?-_ 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. JOBADDRESS AND LOCATION------1023--.Eden--Rd. -------------------------------------------------•-------- ---•------------..._....-------------------------------- Owner's Name--------------r`''----r-`-'----p-ahl---------------------------------------••------------------------------------------------------------------ Phone-2--6-1' fl.......----------- Address .............................._----------•---___--------------------- Contractor's Name------------------ elta----------- ----•------ -•---- Phone----3.x' 955-------------- -------------------------------------------------------------------------- - - Installation will serve: Residence& Apartment HouseE] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __Z___ Number of bedrooms __3---- Number of baths 24--_ Lot size -z__ae e_________________________________________ Water Supply: Public system ❑ Community system '❑ Private ® Depth to Water Table10----- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g] Hardpan ❑ Previous Application Made: Yes ❑ No K] New Construction: Yes &I 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-------81-_______.Material------CeIDBn —brj Ck E4 No. of compartments----Z-------------------SizeX X .._________Liquid depth___'&3-_.____-Capacity--- �_q"l Aa— Disposal Field: Distance from nearest weli_301________Distance from founda�tir �Q-________.Distance to nearest line____ e_.____. ® Number of lines_____________-1-------------------Length of each line___ ____.__ Width of trench_ ___ -_________-____-____-______ Type of filter material__rock---------.Depth of filter material--1 ________________Total length___JB0�__-__-_ -------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material-------------------_---Size: Diameter-----------------------Dept h--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________--____________________•_____. ❑ Size: Diameter--------------------------------------Depth_---------------------------------------------------Liquid Capacity-------- ------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest b0ding------------------------------------------ F1Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- a Remodeling and/or repairing (describe):-----------------N o ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------•----------------- ---------------- --•---------------•---------------------------------------------------------------------------------------••----------•----------------------- 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. Owner and/or Contractor By:------ P_0rr•Y---X4rthan----IAN----------------------------------------------------------------------(Title)---Owner-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 I APPLICATION ACCEPTED BYE�-------------------------- --------- ---------------------------------------- DATE-�--- ----------------------------------------------- REVIEWED BY------ r `'--------------------------------------------------------------------------- DATE-- <,, BUILDING PERMIT ISSUED---------------------------- DATE------------�----------------------------------- Alterations and/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- --------------- -------------------------------------------------------------------------•--------------------------------•-------------------- -----•-----------------------------------•-•------------------------------------------------------------------------------------------- -------------•--------------•-------------------------------------------------------- ----------------------••--- -�k--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------- ------------ ----------------------- --- x. f - -r- ------------------- -•--------------------------------------------------r---`--- -----1- ----------- - ---------------------•- X FINAL INSPECTION BY:------ 1`7_ y- : Date--------71� � ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 5tockton, California Lodi, California Manteca, California Tracy, California ' ES-4-2M 8-51 Revised W-2100