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�F APPLICATION FOR SANITATION PERMIT Permit No/ .....O (Complete in Duplicate) 0 A e 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 .. 21$ ----- 21$x_-3:._ a ------ - --._ ----- - Owner's Name..................xar0ld H&rd111--------------------------------------------------------------- q -- - Phone•-4-"C�t ` Address_ •_2184_. 0...Aah ------------------------------------------------------------------------------ - ----------------- Contractor's Name----------Djel-t------ --------------------- ----------------------- -------- --------------------------- ----- Phone-----3=39,56............ Installation will serve: . Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1_ Number of bedrooms z----- Number of baths ---1. Lot size ...... x- 12 ----_------------------------ Water _--_--• ------------------ Water Supply: Public system 9:1 Community system ❑ Private ❑ Depth to Water Table --------'ft. Character of soil to a depth of 3 feet: 'Sand ❑ Gravel ❑ Sandy Loam ❑_ Clay Loam ❑ Clay ❑ Adobe 29 Hardpan ❑ QQ_ Previous Application Made: Yes ❑ No [51 New Construction: Yes' ] No ❑ ''` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available-within 200 feet.)•- Septic Tank: Distance from nearest well-_.--5V Distan a from foundation -• : Material Cei'i'ient-br1Ck i�GJ Na of compartments___________ ___________Size_.7 .X x4�__t.____Liquid depth_- :��___-_____Capacity....$Q(J_............ Disposal Field: Distance from nearest well__-_3 ..._.Distance from founda#i�ons-------0----_--____Distance to nearest lots line...... ....... ET- Number of lines._. 1... .___.. .__- ._-_:_-Length of each line--4© ..................Width of trench. 2' Type of filter material-------ro.c ._._._ Depth of filter material__18 N------------Total length-.401 1 Seepage Pit: Distance to nearest well ____ _�_______Distance from foundation --1Q� Distance to nearest I t o 1------------ brier f---� ------- [� Number of pits------- Lining material______ _ _ _____Size: Diameter_______. ______.-___Depth ----------- Cesspool: _ _._...._ Cesspool• Distance from nearest well-----------------Distance from foundation............ --___:Lining material-_-_-____..-__-_____------__.......... ' ❑ Size: Diameter------------_-----------------------Depth------------------------------------------------.--Liquid Capacity ---------------------gals. Privy: Distance from nearest well_____________--------_--------_---------.--.Distance from"nearest building------------------------------------- 171 ___-___ _-___-• ---•_.- ❑ Distance to nearest lot`line--------------------------------------------------------------------- --- ----- •------------- Installin new s stem Remodeling and/or repairing (descnbe)�------------ ---- ---------�---------------�----------- ---------------------------------- -•------------------- ---------.:_:.---- ----------------------------------•........................................................................................................................................................................................... -------------------------•---------------------------------•-- ----- - ----= ------------ ------- ---- --------------------------------------------------------------------------------------------- ---- ---- -------------------- ------------- ..................... r I hereby_certify that I have prepared this application and that the werk will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) Aelt.€...Sem t- G- T-ank-s e_ry i, e__-__._ -----------------------------------------------------------(Owner and/or Contractor); ._.. Ferri! W�rth::n Owner-�M- r.----•- ------ -••• - ---+--�--- •-,------------------------------------------------- (Title)-- -------------------------------------- By: (Plot plan, showing size of lot, location of sys em in relation to wells, buildings, etc., can be placed on reverse side). . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.�------- ------ DATE-__---------_---_ l REVIEWED BY................................... ---------•-- DATE_/� x BUILDING PERMIT ISSUED -------- -_ ------------------------ ------- - --- DATE.. .------ Alterations and/or recommendations------------------------------ ---- -----------------------------------•----- ------ ----... ......------------••. . ---•-•------••--- FINAL INSPECTION BY:.... -------, 1-_---- -.._--_- ----- Date------------ t ................................ 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-9-2M 8-51 Revised W-2100