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APPLICATION FOR SANITATION PERMIT Permit No-'A__A:!l_____ r .0 (Complete in Duplicate) Date Issued_`7-- Application is hereby made.fo the San Joaquin Local Health Disirict 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 419 S. olive----------------------------------------------------- ------=----------------------------------------------------------------------------------------- Owner's Name---------Mrs.--------Anna sWeB'�eII ------------------------ -------------- Phone----------------------------------- Address 419 S:' Olive ----------'---------------------------------------------- -------------------------------- Contractor's Name o-------------------A t -----------------------------------'Phone----3...395,5------------- Insta9lation will serve: Residence Apartment House -1 Commercial ❑ Trailer Court ❑ Motel El Other ❑ ...- k:E Number of living units ---- Number of bedrooms ---2-- Number of baths -__I_ Lot size _-____ -_1Q-Q__________________-----_ _ ------ I Water Supply: Publics stem Community system Private Depth to Water Table .----_-_ ft. l; Rp Y� Y � Y Y ❑ ❑ p - Character of soil to a depth of 3 feet: Sand ❑ Gravel F] Sand_y Loam [-] Clay Loam E] Clay 0 Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No [I New Construction: Yes ❑ No a TYPE OF INSTALLATION AND SPECIFICATIONS: 1 ~ (No septic tank or cesspool permitted if publicisewer is available within 200 feet.) { Septic /� No. of compartments---------------------` Distance from foundation--------------------Material ��,,yy�TT -------------_---.-------------------------_-- e tic Tan Distance from nearest well-----------------' ---Size--------------------------------Liquid depth--------------------------Capacity----_------------------ Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-------------- I EXTSTUG Number of lines-----------------------------------Length of each_line----------------- -__--------Width of trench---------------------- Type of filter material-------------------------Depth of filter material--------..-------------Total length --------------------------------------___ls�4 _ € Seepage Pit: Distance,to nearest well._._!QO---_-----Distance from foundation-__-101----- - a .Distance to .nearest lot;line__.�y Number of pits---------------�._---Lining materiall\b�C ------Size: Diameter----3-0-_----_____-.Depth---2_I�__----------_____ Cesspool: Distancefrom nearest well-----------------Distance from foundation------------------- Lining material-_-_- .-__-.----- _ - ------------- El Size: Diameter--------------------------------- ----Depth---------------------------------------------- -----Liquid Capacity---------------------- gals Privy: Distance from nearest well-____________________.____--_-___---------__ _-Distance from nearest building----------------------------------------- Distance-to -._---________________-----------.--:--- Distance to nearest lot line_____________ • g / repairing 1 nem- Y ui_eel---drain.-A-f---P0_ae_1bl-e---- ----- Remodelin and or re airin describe :______1�3� ; --------------------------------------------------•--------•------------------•-----------------------------------------------•------------------------------------------------------------------------------------------- . 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 6f the San Joaquin Local Health District. (Signed)-----------D 7JC__Ta11k � x'V1C (Owner and/or Contractor) ------------------------------------ BY:------ -P 'rr -- - - --------------------------------------------------(T;tle)-------Owner-Mgr.--- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ----- -----------------"----------------------------------------------------------- DATE---- REVIEWED BY----------------------- ---------- �`-�. DATE_. -- ------------------------------------------------ BUILDING PERMIT ISSUED--------------- -- - �l Alterations and/or recommendations' ° A - .�. 1�__G�---PW---------- --- -------------- ----"_.._.-----------------.-----------------------------------------------------_ --_ -------- ------.-.--------------------------•--- ----------------------•_1-f-.___--------_ __-----_-•--------------------- ----• . -._._.-._�_________________ --------_.P_-_. FINAL INSPECTION BY:-------- Date---------------- - 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 B-51 Revised W-2100