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APPLICATION FOR SANITATION PERMIT Permit No. -__-__v�__ _,d (Complete in Duplicate) n C 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. JOB ADDRESS AND LOCATION...___.�9-Sou-�h Hi Way 50 half way between Hospital. Lane and - ------- - - �, - ------ ------- - - - Owner's Name--------------------------- T C<f -- •K=4� 11--------'-------------------'------------- --------'-------------------`-------------- Phone__37 �30_-_.-------•---- Address---------------- ------------------•1211_Turnpike--- oad-------------------------------------------------------------------------------------------------------------------- Contractor's Name-------------------- s ---A"__PA_RRI_3_H---&---SQ_RS_,___1TSC, -------------- Phone- 97 §07----------- -- Installation will serve: Residence)= Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � Number of living units-_______ Number of bedrooms 2____ Number of baths _1___ Lot size30-1---X---15a,__________________________ F Water Supply: Public system ,$) Community system ❑ Private ❑ Depth to Water Tabld.51_"'ff. � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamX] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: Yes ❑ NoX] New Construction: Yes M No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest wel6j)-._.........Distap frollfoyaid tion__-15-1---------Material- C Hr's C11C$ ------------ �4 WC No. of compartments--------- --------- ---Size`?_---- 3-bb----ebb- ----Liquid depth---S--------------------Capacity---_ 4---G1 t I Disposal Field: Distance from nearest well---7O-r------Distance from foundation2.5!-------f__-Distance to nearest lot MC Number of lines------------a-__---------_--------Length of each line_ __/_I -.__-.Width of trench--------2411---------_.______-� ` Type of filter material_- !__-__RX___Depth of filter material1-811---------------Total length------5Q_1---------------------------- _/'1 . -----------------"Seepa Distance.to'nearest,-well - .1 Distance fromwfounk ion .,R - .� r,•''I'do —si mber of pits - ateria � -----$t : Diamto___4811--------- Depth__- -------------------•---- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___________-____________-____._____ P ❑ Size:~Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest wel€_____ ---------Distance-from near-est.buildi.n I ❑ Distance to nearest lot line------------------------------------------------------------------ --------------------------------------------------------------------------- Remodeling and/or repairing (describe)_____________j� w-__ sta11a i b --------------------------------------------------------------------------------- ----------------------------•--------------•------------------------------ ---------------------------------------------------------------- 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) P�T __SQISx ZNC.-.-. .-. • • `,•• • . • .•-. •• • ' " �� Contract i - -- + r ♦ (Title} ._ Qr --------------------------------- By:--- I (Piot plan, s o ing size of lot, location of ystem in relation to wells, buildings, etc., can be placed on reverse side).14 • FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ = DATE--------- �� I REVIEWEDBY- - -------- -------------------------------------------- ---------- r , DATE BUILDING PERMIT ISSUED------------------------------------------- � --------------------------------- DATE--------------------------------------------- -- ------------------------------------- -- ----------- Alterations and/or recommendations----------- ---------------------------.---.------------___-.- --____-- ---------- �` �-_------�-r 4f� c�► �N---- -- --•- r--------�C!�Y °u l ---- ------1 ---- i +f <t c '-------------- ---- -------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- i ------------------- -------------------- ----------------------- -- FINAL INSPECTION BY:----- ------ ------------ ------------------------ Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 1 Stockton, California Lodi, California Manteca, California Tracy, California I ES-9-2M 8-51 Revised W-2100 j