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.a <br /> APPLICATION FOR SANITATION PERMIT Permit No. . .. <br /> (Complete in Duplicate) Date Issued ... �.�- <br /> 11ti10 <br /> Applica+ion is hereby meds to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-------2321---E•-•-An1t.R-------------------------------------------------------------------------------------HO---4--4+78Z <br /> an3Fl <br /> .. arenr,,e-- ..... -. Phone.-M& _11.07 _L,A. . <br /> Owners Name._._..�.ga.1:=---�+--- MZiUC�'a-------------- ----- ------------------------------------ <br /> Address----------------- -----Cf_o.11 f...................................................................................................... <br /> Contractor's Name....Dn1 tia..s..--InC-•----------------------------------------------- -----. Phone_. <br /> Installation will serve: Residence FL) Apartment House..❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: ...a,.-- Number of bedrooms 2----- Number of baths .__1. Lot size .--_-.75x150------------------------------------ <br /> Water Supply: Public system $] Community system ❑ Private ❑ Depth to Water Table .--40 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[3 Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [I New Construction: Yes 91 No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well------------- ---Distance from foundation....................Material--..._._.:...-..__-_-_-_--_-.---._----.-.-----.-. <br /> exist.ng No. of compartments--------- ------Size---------------•----•• -•-•••.Liquid depth---------- -- Capaci}Y....................... <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation___--.-.-- -_-_---.Distance to nearest lot line................. <br /> exisUrig Number of lines-----------------------------------Length of each line---------------------------...Width of trench----------.-------------------_-- <br /> Type of filter material---- ---------------Depth of filter material.: Total length--..-___.__-..---.-- --__-_..... N <br /> 5' <br /> Seepage Pit: Distance to nearest well_ no---------Distance from foundation.....10--_._...Distince to nearest Iot 1 ................ W <br /> ] Number of pits--.I--:-----_---..Lining material...._br ck__Size: Diameter-_--.-._� -- ----Depth--. ...(/ N <br /> Cesspool: Distance from nearest well_-_-.._-.- - Distance from foundation-------------------Lining material------------------------------------- <br /> El <br /> .---_----_-_--_--_-_-_------ ._-__ <br /> Size: Diameter--------------------------------------Depth--------------------- -----------------------------Liquid Capacity gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--__----._---_-_-.-._____------------_--. <br /> • <br /> ❑ Distance to nearest lot line--- ---- ------------- <br /> Remodeling and/or repairing (describe):--_-.---&3-13ag...YG'r .-_s�S' _ ?_..t0__e It-1 .-. �steTfi <br /> ----- ---------------------------------!----------------------------------------------- <br /> - r <br /> ------------- -----• ..........-----•.........-•-• .----•-•-•----•-••••---•-............----••......•••.......................................... <br /> --- — <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)...............Delta.,----Trio.------------------------------------------ -----------------------------------------------•-•--- ... ---...(Owner and/ .Contractor) <br /> Gen.M r. <br /> By:............Berry.-amthan---------•••-----------------------•--•--------•------......---•-----•--••------..(Title)-----------•----g--------------------------------- ------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ACCEPTED BY-------- DATE �y t-: .. <br /> _-----­-------­--- <br /> APPLICATIONREVIEWED BY------------------ --------------------------------------------------------- DATE------------------------------ ----n`-- .. <br /> BUILDINGPERMIT ISSUED................................................--------............................................ DATE-----------------------------:--- ........................ <br /> Alterationsand/or recommendations:......................................................................................................................_._v,....................................... <br /> ------ -------------------=---------------------------------•------------------------•-•----•------ <br /> ---------------------------------------------------------- -------- - - ----. ...-- ------ ----- --------------------------- <br /> ---- ----- -------- ............. .. . <br /> ( ,�. � 6� 11/ / <br /> FINAL INSPECTION BY:. -•------ ---- -- --- Date-... <br /> ................... <br /> SAN JOAQUIN LOCA(. HEALTH,,�STRICT <br /> 130 South encart Street 3bo Wast Oak Street 132 'Sycamore Street 8W North "C" Street <br /> Stockton, California Lodi, California Mantow,•California *' '''lraey, California <br /> ES-9-2M ; `Revised W-2100 <br />