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-le— Permit No. __3_+ � APPLICATION FOR SANITATION PERMIT' ______ Duplicate)(Complete in Dup pate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544. JOBADDRESS AND LOCATION---------1E35---E--.---P-nplar-------------------------------•---------------------------------------------------------------------------------- Owner's Name-----------Kr-'-- -------------------------------------------------------------------------------------------------- Phone------3-5634------------ Address.....---- -=t%------------------•--------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- Contractor's Name------Ile-lt a------------------•------------------------------------------------------------------------------------------------------ Phone----3-3-9-55-------------- Installation will serve: Residence [�j Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-1,_-_ Number of bedrooms ----2- Number of baths 1------ Lot size _____ _ x14Q-------------------------------------- Water Supply: Public system ® Community system [] Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 12 Hardpan [] Previous Application Made: Yes ❑ No ❑c Now Construction: Yes ❑ No ❑x 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 ________________________-_.__..________-_______- EKISInNG No. of compartments--------------------------Size----•---------------------------Liquid depth--------------------------Caaci Disposal Field: Distance from nearest well-------------- from foundation--------------------Distance to nearest lot line________________. EiIS01KG Number of lines___________________________________Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material----------------------- length----------------•--___________________--- Seepage Pit: Distance to nearest well-----r__--------------Distance from foundation------B..........Distance to nearest lot line----_-_-5--____ ID Number of pits-----I--------------Lining material----br-lek-----Size: Diameter-----3................Depth----],0-----------------------' 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)----------lna:.allat-Ion---af----&UMP---aUJ.Y-------a;nd---haaki-n•&-t-o---t-x-1g-t-tnjE- dra-inaE;&---f-ie ld...wi-t-h---80-1 d----Zine-------------------------------•-----------•----------------------------------------------------------------------------------------------- ----------------------------------- -----------------------------------------------------------------------------------------------------------•-------------------------------------------•------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------- 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)-----------AEIta-----------------------------------------------------------------------------------------------------------------------------------------(Owner and/or Contractor) By:-------------Parsy----dar_thL=---------------------------------------------------------------------------------(Title)-----Q-Wner Xgr-.------------------------------ (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 REVIEWED BY_ACCEPTED BY ---------------------------------------------- DATE --------------------------------------------- -------- -- ---- ------------------------------------ ------- ---------------------- �4 BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------- ---------------• DATE--------------- and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- ---------- ----------------------------------•---------------------------------------------------------------- ---------------------------------------------------•--------------------------------------------------------------------------------------------- ----------- ------------------------------------------------------------ ------------------------------------------------ ------------------------------------------------------ ------------------------------------------ ^ ------------------------------------------------- FINAL INSPECTION BY: -------------------------- Date - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, Celifarnia Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100