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APPLICATION FOR SANITATION PERMIT4k 1 (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install fhe work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------ 812---Berkeley -- ____ ------- arles Roberts f' _---- Owner's Name - Ch- •---------------------------------------------------------------------------------=----------------------------- --------------- Phone Address--------- 1812---Berkeley------------------------------------------------------------------------------------------------_ ----- _ . -------------------------- Contractor's Name----------------------------DE:Zt$ -------------------------------- -------------- -------- Phone 3.955 I Installation will serve: Residence® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:?I Number of bedrooms E? Number of baihs'❑2 Lot.size------10X13-0_________________________________-.-_ Water Supply: Public system [3L Community system ❑ Private ❑ Character of soil to a depth of 3 feet:- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe [A Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: J (No septic tank or cesspool permitted if public sewer is available within-200 feet.) Septic Tank- Distance from nearest well------------------Distance from foundation---------------------Material.--_--______--------__-__-_.___------_--_----.-_. J� EXISTOG No. of compartments--------------------------Capacity-----------------*--=--Size------------------------------Liquid depth-------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material---------------------------------------- Size: ___----- --_-----____-----_____-_-_Size: Diameter------------------- -------------~----Depth----•-----------------------------------•---------- �I !rPrivy: Distance from nearest well_______________________-_--______-.------_-----Distance from nearest building---------------- -----__--_--_-_--_--_--.i ❑ Distance to nearest lot line------------------------------------------------ �- Seepage Pit:.:«. - Distance to nearest well____________ ______Distance from foundation__5'_-=_.--------Distance to nearest lot line -------- -__--- Number of pits----------�--__�__-_Lining material___-_-!XX!14__Size: Diameter---I�[hd_-_---.Depth---------�5-_------ . Disposal Field: Distance from nearest well------------------Distance from foundation----_---------------Distance to nearest lot line____._-...-..---- EXIST9TaNumber of lines------------------=---------------Length of each line-----------:-:------------ .Width of french----------------------------------- Type of.filter material-------------------------Depth of filter material--------__----------_-_ Remodeling and/or repairing (describe)F---_ Installing new vertical drain only and hooking up_ - to--_the --existing---septic tank wi th solid line;��---------------------------------------------- ------------ -------------------- ------------------------------------------------------ ------------'-------- ----------------- ------------ -- - -------------------------------- ------- --- ----------------------------------------. - ----- . k I hereby certify that I have prepared this application and that the work will be d nein accordance with San Joaquin Caunty ordinances, State laws, and rules and regulations .of the San Joaqu' oca Health rict. (Signed)----------•-------e.11a---------- -- - -- ..-- - -------------------------(Owner and/or Contractor) Perry Warthaup - --- --- / -- Tale Owner-Mgr. By: -----=------ ----- F ( } (Plot plans, showing size of lot, location of sysfern relatf�fo ell s, buildings, etc., must be fled with this application). P FOR"DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------------------------- ------ ---------------------------------------- DATE---9 = REVIEWEDBY ------------------ --------------------------------- DATE- -- ------------------------------------------ BUILDINGPERMIT ISSUED-----------•------------------------- = ------- ------------------------------------ DATE------------Q --------=---------------------------------- Alterafions and/or recommendations------------------ ; ' - -----------------------•------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- ---•---------------------------------------------------•------------ ------------------- --- ... ---------------------------------------. _-._. I--.-------- -------------------------- ---••-------------------------•---••-------------•---•-----------------------•------------------------•------------------------------------------------------------••-----•------------------------------------------------- PERMIT No------ ISSUED--------- _-_�l -- ------(Date) FINAL INSPECTION BY:-------- ---------- -------------------- DateY--------! ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E'S-9-2M 9-50 W=1639-