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n ;_7 APPLICATION FOR SANITATION PERMIT Permit N a - (Complete in Duplicate) -2.1 I � � Dere 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 incompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION At. 'S2 • - Owner's Name.........AI.VJ nQ-.9,._.0 X C s ---------------------------------- ----- - - --- ------------- ------------ Phone--n--------------- --------- Address-------------------711-'`�� Antero$. s ----- •---- ••. •. ------ Contractor's Name Re 11 - - ................. Phone-- ._. ?? •--------- t Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1___- Number of bedrooms .2____ Number of baths ._l.__ Lot size _50XI5.0- -._.-_•-- ------ --------- Water Supply: Public system [k Community system ❑ Private ❑ Depth to Water Table 3.0.- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑- Adobe[I Hardpan Previous Application Made: Yes ❑ No [2 New Construction: Yes W No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welIA01 0.....Distance from foundation------10 ......Material----------- rXI No. of compartments------------2:•_--------Size--6-._ 1- 4l t - 4 �emEtlt- bri__ - ----- Lp -- -t t --------Capacity-AN ------ Disposal Field: Distance from nearest well--- Distance from.foundation_._!.0I....._...Distance to nearest lot line-..--5.......... III Number of lines_----_l___ __________________Length of each line-------- 4 t ___._ .Width of trench _____.2----------------------- Type of filter material-_ ra0.4 Depth of filter material 1$tt .Totallength---------- t .... Seepage Pit: Distance to nearest well_ _____________•-_-Distance from foundation...................-Distance to nearest lot line........................_ ❑ Number of pits----------------------Lining material..-..-----------------Size: Diameter---_-----------__Depth----_----------------. ~ Cesspool: Distance from nearest well...... .........Distance from foundation_______- .-__-__--Lining material_ __.-.. ._--<.._ ❑ Size: Diameter--------------------------------------Depth---------------------------- ----•---------------Liquid Capacity. ..-_- ------ __gals. �V Privy: Distance Morn;-Rearest well___________________ __________________________Distance from nearest building------------------------------------------ F1 __-. __3333_.. ------ --------- ❑ Distance to nearest lot line Remodeling and/or repairing (describe):.......__..Nx► _....._. ......... •-•-•-- . .----- ----- ------- -------- -------- ---.---- -------- ------- ------ ------------------------------------------------ --------------------------------------------------------------- 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 eltja--------------------------------,_� --------�j - ---- ------(Owner and/or Contractor) By: '! ]s;"�'.. n f!'�,F�'---------- ------ •----(Title)- dw 1 z' M ------_---------------------- (Plotp g ize of lot, location of system in relation to walk, buildings, etc., can be placed on reverse side). Ian, showing s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - ----- - - DATE - REVIEWED BY DATE , - ' �S: • •�I �"_ BUILDING PERMIT ISSUED -• •------ --------- _--- -_--------------------------- DATE- •--- Alterations and/or recommendations----------------------------------__------------------------------------------- ---------------------------------------------------- FINAL --------FINAL INSPECTION BY:-- - - ---- . ---------. ----- ---- --- -- ------ Date------� �------- , 6� SAN JOAQUIN LOCAL HEALTH DISTRICT a Louth American Street- 300'West Oak Street 132 Sycamore Street 814 North"C" Street Stockton, California Lodi, California Maned, California Tracy, California ES-9-2M 8-51 Revised W-2100