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Y APPLICATION FOR SANITATION PERMIT Permit No: (Complete, in Duplicate) .S Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 1 This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION 723---- -----------•----------------------------------------------------------------------------------------- Owner`s Name-------------Alonzo._TNI-I te---------------------------------------------------------------------------------------------------- Phone----4--9,'31--------------- Address.....--------------------same----------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- ,1 Contractor's Name D - ------------------------------------------------------------- --=---------------------- Phone__.-3W-3955-------------- Installation will serve: Residence [3t Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of Living units: __l___ Number of bedrooms __ 2____ Number of baths __1___ Lot size .....60 x 105 FWater Supply: Public system ® Community system ElPrivate ❑ Depth to Water Table _30_ ft. CCharacter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ I Previous Application Made: Yes ❑ No Elx New Construction: Yes [2 • 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_________________Distance from foundation-------------------Material------------------------------------------------- No. of compartments Liquid depth Capacity ex�t�in� p q p ------'---------------- Disposal Field: Distance from-nearest well------------------Distance from foundation--------------------Distance to nearest lot line______--________ 4 ex Ian,f ng Number of lines-----------------------------.-----Length of each line------------------------------Width of trench-----------------------------------� Type of filter material-------------------------Depth of filter material-----------------------Total length-----------------------------------------_W Seepage Pit: Distance to nearest well------11_Q----------Distance from foundation____19----------Distance to nearest lot line------5__-_____. Number of pits___-----------------Lining material____rr_f CX____Size: Diameter---------1_------------Depth_________20_________________ Cesspool: Distance from nearest well____________-_-_Distance from foundation___________-____.Lining material-------------------------------------- " ❑ Size: Diameter-- ----------------------------------Depth---•------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------------------7-_Distance -from nearest buildiiig_; _____ '---------------------- El =:_: ____ = __❑ Distance to nearest lot line-------------------------------------------------------------- ---------------------------------------------------------'---------- Remodeling and/or repairing (describe)-------------------V_art------------------------------------------------------------------------------------------------------------------------- --------------- ------------------ ----------------------•------•-------------- ----------- ----------------------------------------------_.------------------------------------.._..---------------------------------------------•----------------------- -----------------------------------------------------------=---------------------•--------------------.-------------------•-------------------------------------------------- ------------------------------------- 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) Delta......It1C--------------------------------------------- ------------------------ ---------------------------(Owner and/or Contractor) `t By:------------------------------------------- - '• 0-• V.- ( --------'----------------------------------------(Title)----- Gen_._Ml- r------------------------------------- f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). j F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------7---- ------------- - DATE----------lz 0o -- 1ZEVIEWEDBY - -------------------------------------------=------------ --------------- DATE r BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE Alterationsand/or recommendations----------- ----------- ------------------------------------------------------------------- -----------------------------------------------------•------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- --------------------- ----------------------- ------------------------------------------------------------- M i --------------------------------------------------------------------------------- r � FINAL INSPECTION BY:---------( "T __z_-________ l/ _ --------._ Date- --J,(---------------- ��~��- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California t Lodi, California Manteca, California Tracy, California i 11 ES-9-2M 5-51 Revised W-2100 +