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o'j ----------- yt, APPLICATION FOR SANITATION PERMIT Permit No. v� Jv ` 5 (Complete in Duplicate) y� Date Issued _S_a____�•�__ t 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. 549. JOB ADDRESS AND LOCATION-------------2 22-- P-onlar------------------------------------------------------------------------------------- ------------------------ Owner's Name------C--•----H_-EaTman------------------------------------------------------------------------------------------------------------- Phone-nO----------------------------- Address-------------------------------------aBa;e-------------•-----------------------------------------------------------------------•------------------------------------•------------------------------ Contractor's Name---------------------------Dell a---------------- -------------- Phone-----3--3955.------------ ------------------------------------------------------------------ Installation will serve:- Residence U Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A— Number of bedrooms __2--- Number of baths ------1 Lot size -_--_75x150_____________________________________ Water Supply: Public system E2 Community system ❑ Private ❑, Depth to Water Table _40_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No E2 TYPE OF INSTALLATION AND SPECIFICATIONS: W (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation-------------------.Material --____________-_--,______________________-____. ,}t TS'lu_. r No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well---------------__Distance from foundation--------------------Distance to nearest lot line__-_____---..-_- .��IS'.EL- - Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material------------------------Total length---_.__-_-________-____ Seepage Pit: Distance to nearest well--------:_o_---__-___Distance from foundation-------.T.Q_......Distance to nearest lot line------- _______. 121 Number of pits__.]v_____________Lining materiaL_br—lC._ Size: Diameter----42tt_ ___________Depth-----3_0---------------__.__._ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter------------------------------------Depth -------------------------------------------Liquid Capacity--------------------------9 a i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------_______-________________________- , ❑ Distance to nearest lot line---------------------------------------------------------____------•--------------------------------------------------------------------- Remodeling and/or repairing (describe)_-----------------InsCalling___42t'___3eer-t—Ical---and___ho-0!U'1 1e----------------------------------------------------- ----------------------------------------------- -----------------------------------------------------------------------------•-----------------...-------------------------------------------------------------------------- ---------------------------------- ------ -- ---------------------I----------- ----------------- ----------------------------------------------------------------------------------------•-------------------- hereby certify that 1 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) Delt-2----------------------------------------------------------------------- --_Owner and/or Contractor By:----------------------,Pex_r-y---Vex tbaxi-----------------------------------------------------------------------(Title)---- �------------------------------- (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-- -y:- ------------------------------------ --------------------------------------- DATE----=='-`---------------------------------------------------- REVIEWEDBY----------------------- -------------------------------------------------------------------------- DATE---------------------•--........ BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------ Alterations and/or recommendations:--------------------------------------------- ---------------------------------------•-------------------------------•-----------------------•--------------- ---------•----------------------------------•------------------------------------------------------------ ----------------------------------------------------------------------------------------•-------------------------- ----------------------------------------•------•----------------------------------------------------------------------------------------------------------------------------------------------__------------------------•---- FINAL INSPECTION BY/------------------• -------__-_-- Date-------r j�` B sW 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