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r VV 8 --R--. !�._APPLICATIO1 ttOR! SANITATION PERMIT P rmit o. • - �� I [�ornplete in Duplicate) g P—(o —S`.2 -- Date Issued " jt Y_ ,;Application is hereby made to the,San Joaquin Local Health is�lctr a permit to construct and install the work herein de l {Th ,application is made in compliance with County Ordinance No. 549. scribed. �4P JOB ADDRESS.rAND LOCATION ----------------940 So. Oro Iw - - -----• ------------------------------------------------------------------------- ----- Owner's:Name---- 2 473 ----------------------- ----- Phone-- ------ - Address.=�°�-------=`--------��5...5.---•Aae3b_ert----- ------------------------------------------------------------------------------------------------- --------------- a Contractor's Name""__""�I 'ia••__-_____ --------------------------------------- E _3955 : -"--- Phone- - -----------------•-------- - Installation will serve: Residence ® Apartment House E] Commercial ❑ Trailer -Court E] Motel ❑ Other ❑ Number ofliving units: _I___jNumber of bedrooms _2____ Number -of baths -1--- Lot size -------50__ Water Supply: Public system RCommunity system ❑ Private ❑ _Depth to Water-Table 4.0-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe [ Hardpan ❑ Previous Application Made: Yes ®: No El Now Construction: Yes 99 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No,septic tank or cesspool permitted if public sewer is available within 200 feet.) c 1 P p nearest well----- Distance e fromlfoundation--------.8 Material- _- cement-brick �P tic Tank: Distance from --------------•--------- fNo. of tom artments- Size --------I----x�------Liquid depths____&)--------- DisposalCapacitY 8f}0 Pq Number of lines 1 _ earest welf___3------_-Distance from foundation--_"10 Distance to nearest lot line-----__ Field: Distance from n nes ------------- T } Length of each line = I---i------ Width of trench i Type of filter material---r'Qg4-----___-- filter maal length Depth of filtterial____ R ------- "To+ -------•----------------------------- -- Seepage Pit: Distance to nearest weft__.--__--- ------Distance from foundation--------------------Distance to nearest lot line # . ❑ Number of Pits----------- -------Lining material--------------_-__ -Size: Diameter_----_-••-- 1 -------------Depth------------------------------ Cess ool: Distance from n� earest well_- Distance from foundation.-_..--------------.Lining material-------------------"-_ ----- P Y Distance from ne --------------------------------------Liquid Capacity--------------------- ❑ Size: Diameter_"__ arest weft--------- ---- -- ------------------------DistanceDepth from nearest building"_."_---"""__"_ __- ___------. r0 _ Distance to nearest lot line" ' -� ' -------- --------- -------- --- -------- Remodeling and/or repairing (describe):----------- _ �1ng'967¢t,"" Of ha�izontal leech drain in t-------------------------------- Remodeling --- ----- ---- ----- - --- ------------ --------------- --end of h 7'1 " ext_i .-".� _ " l--------gin---tg--hp-- 4 ilZed--in wi'lrh dirt by iuS ------------------------- ----------------------------------••---------------------------------- ---------------------------------------- ------------------•------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Gounty 4 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------•---------- Cpl "S- "" ' rnk ; °v-_ ce g Perry Warthan [Owner and/or Contractor') ---------------------------------------- --------------------- iY:----------------- ----------------------------- ' f Owner—Mgr.- By: - - 9 [Titl(Title- -- ________________________ Pot plan, showing size of lot, location of syste in relation to wells buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY--(:Z-` ---------- ------- DATE ik-------------------------------------------- REVIEWED BY `------ -- -------------------------------------------------------------------------- DATE--__- - ! BUILDING PERMIT ISSUED------------- - _ ----------------------------------------------------- DATE Alterations and/or recommendations:__ 'Z.;"""""- - ---------------------------------------- -------------------------•-----•------------------------------------ --------------------j..... ---------------------------------- r •------------------- FJNAL INSPECTION BY: t4 Date -------------------------------------- ----- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streof 300 West Oak Street 132 Sycamore Street Stockton, California � 814 North "C" Sfree+ Lodi, California Manteca, California., Tracy, California ES-9-2M 8-5f Revised W-2)00