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f F �+ y APPLICATION FOR SANITATION PERMIT Permit I4lo o •--------------- (Complete in Duplicate) 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. 544. JOBADDRESS AND LOCATION------------10 N Funston---------------------------------------------------------------------------------------------------------- Ownef's Name---------Mr------E mond---Plat-ens-------------------------------------------------- Phone_ ------"�80 Address----------se--------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------------------- Contractor's Name----------peltr�-'-- -------------------------------------------- --- ------------------------------- ------------•--- ----------- Phone----------33955----------------------- 1 Installation will serve: Residence ❑ Apartment House ® Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 3"----; Number of bedrooms --- -- Number of baths ---R-- Lot size ---��x�-��- Water Supply: Public system U Community system ❑ private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe n Hardpan ❑ Previous Application Made: Yes ❑ No ❑X New Construction: Yes ❑ No 4�] 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-__------___-_----.Material----_-------"_--_-_-______--------------_----"- h � No. of compartments Size--------------------------------Liquid depth-----------------------Capacity----------------------- EXIST Ti3G Disposal Field: Distance from nearest well--------------------Distance from foundation--------------------Distance to nearest lot line.---"-_---------- EXISTUG Number of lines------------------------- ------Length of each line------------------------------Width of trench-------------------------------_-- Type of filter material-------------------------Depth of filter material-----------:-----------Total length------------------------------------------ . s Seepage Pit: Distance to nearest well----"-----in"--______Distance from foundation_-----5 f- -""_--.Distance to nearest lot-line-_-_5-_---____- Number of pits--------I------------Lining material_brj—c-k-----Size: Diameter--------4--------------Depth--------2 "__ax -" T` Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------"- T '�Li u id Capacity. -" als. ❑ Size: Diameter--------------------------------------Dept h-,---------------------"` q P Y 9 r Privy: Distance from nearest well. __--------------------------------_-___-___--Distance from nearest building---------.__.__.---_----"--_-----__-----. ❑ Distance to nearest lot line----------------------------------- - ----------------------------------------------------------=---•---------------------------------------- Remodeling and/or repairing (describe):--------___-ITIS_taill1arE--_-�41__-_—vert. c-&I.-drain-_and___h�okln�__ti�J t0 ti hex-at-j-nG---i&&pt4�---tank--art al?d Jmit -------------------------------------------------------------------------------------------------------------------------- - -. - --------------------------------------------------------- -------------------------------------------------------------------•----------------------------------------- - 1--- ----- - - ------------- I hereby cer+ify 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 +he San Joaquin Local Health District. 4 (Signed)r-•-------------X3eltA---- ------------------------------------- ---------------------------------------------------------------------------(Owner and/or Contractor) if o location of system in relation to wells, buildings, etc., ca (bele)laced Con reverse�� B � xirY- +�arthan---------------- =---- (Plot plan, showing size of lot, y g p side). ' FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- ------ --------------------------------------------------------------------------- DATE ----------------------------------------------- REVIEWEDBY------------------------------ `---------------- --------------------------------------------------- --._ DATE �'� BUILDING PERMIT ISSUED----------- DATE ' -- Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------`---------------------------•-----•--•---- ---------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ FINAL INSPECTION BY.--."14 -------------- 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 f 2M 8-51 Revised W-2100