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APPLICATION FOR SANITATION PERMIT Permit No. _-�-_��/___X_-_ ' (Complete in Duplicate) Dade Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install This application is made in compliance with County Ordinance No. 549, s II the work herein described. JOB ADDRESS AND LOCATION------------31___!x_- Oro - -- -------------------------------------------------------------------------------------- --------------------------------------------- Owner's Name-------------------------- 5xth=----��t...0 aLMdI ------ Phone----4--9-046---------------- 1 -----------------------------•---------------------------------------------------- -- Contractor's Name------------D.c-_Lto------------------------------- + ------------- ---------- • ----------- -------------- -------------------------- Phone---•--�-3255 Installation will serve: Residence ® Apartment House [-] Commercial F] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1---- Number of bedrooms -----I_ Number of baths __!--- Lot size -------72 17a ` ------------------------- Water Supply: Public system ❑ Communitysystem y stem ❑ Private ® Depth to Water Table _--�Dft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: Yes ❑ No © New Construction. Yes r] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) kAd Septic Tank: Distance from nearest well---5Q--------Distance from foundation------8;_.-------Material _-Qe Ze 1t-_br_iC__k_ ® No. of compartments-------Z----------------Size---6-rX4'_x4.-__---_Liquid depth----5'-&.3...........Capacity-- G0------------ Disposal Field: Distance from nearest well-,---------------Distance from foundation--------------------Distance to nearest lot line__---____-_-- ❑ Number of lines-----------------------------------Length of each line---------------_------------_-Width of trench------------------------__ Type of filter material-------------------------Depth of filter material-------------------..__Total lengfh------------------------------------------ Seepage Pit: Distance to nearest well--------75=__-___Distance from foundation------!Q.-------Distance to nearest lot line------5-r ® Number of pits-----------1--------Lining material----A1 iL'-k__--Size: Diameter------42.. .----.Depth-------10------------_____-_ ------- 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 ❑ Distance to nearest lot line--------------------------------------------- .. Remodeling and/or repairing (describe)--------------------------%EW ---------------------------------------------------------------------------------- •-----------------------------------------•-------------------------------.-.-------------------------.---------------------------- 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)---------------- - ----------------------------------- -- -- -----(Owner and/or Contractor) { �Y� --------------Perr3'----Warthar__ ©= ----------------------- -----(Title}------0_y��;ex-iris ' (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 -- -------------------------------------------------- WED BY ------------ --- --- -------------------------------------------- --------------------------------- DATE ---' --- ------ - BUILDING PERMIT ISSUED ----------------------------------------------------------•-- DATE------- Alterations and/or recommendations---------------.__---__-__-._-___ ---------------------- ------------------------ ------------------------------------ --------------- --------------- ------------------------------------------------rt---- ----------------------------------- FINAL ------------------- FINAL INSPECTIONBY:----------��------ -------_- _- 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