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APPLICATION F R SANITATION PERMIT Permit No. '3.. -_------------- (Complete in Duplicate) -- _ _ Date Issued))_ Applical'ion 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. J08 ADDRESS AND LOCATfON-- .800_._Slk.a So's endo '1 ) Tentatt" �V Is— -------------- 'l Ernie �e�i hnson, Plaster-I Contre, 'tom pur�,r�ton �J 2m .2m- 6 Owner's Name----- _-u Phone -------3C-3--9 1729 S--••------- atft' Stod oa Address - ...._ .. if---- __ f------- -- -------•--------------------------•---------------------------------------------- ------------------- P�� s Ilfi Contractor's Name.-----•-•------•-------•----------=•-------------------------------- l=---------------------------------..-..-------------------------------- Phone----•---•------------------------- Apartment House [:]l Commercial E] Trailer Court ❑ Motel ❑ Other E]Installation will serve: Residence { Number of living units: __ _. Number of bedrooms --- 11 Number of baths ___ _ Lot size ------P_ __ _.__ __ a_ _________________________ Water Supply: Public system 4 Community system El Private ❑ Depth to Water Table_-- ft. Character of soil to a depth.of 3 feet: .Sand ❑ Gravel ❑I, Sandy Loam ❑ Clay Loam E] Clay E] Adobe J§ Hardpan ❑ Previous Application Made: Yes [-] No E . New Construction: Yes ] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: If (No septic tank or cesspool permitted if public sewerisavailable within 200 feet 103 CC Brick Septic Tank: Distance from nearest wgll-------------- --Dist' fr 4oundation--------------------Ma ial--_--_______--___---_____ of compartments--------------------------Size _ Liquid de th_________________--------Capacity----------------------- No. lYi�e PP 9t7� .erg -.---.Distance to nearest lot line___1� Dis asal Field: Distance from near�st well_________________--Distance from foundati n__. _ _ _ ---__---•.--_ ' Numberof lines------------- i-ength of each line _ Width of trent -f_- ._.--_--------._- -'Rk---- a-- � Type of,filter material-------------------------Deplth of filter material-----------------------Total lsnc�th-._._-______--___------__-----••-----_.._ r - •50 + 1 Seepage Pit: Distance to nearest w�______�_____________Distancc3, o�_fqu��ation_._._....___.___.._.D•st ce to nearest lot lin ____, - Number.of pits-------=------i 9 it .----maize: Diameter-------------- ---Depth----------; --- -----.-Linin material--- -------------- a2 ]Ina Distance from nearest we}l------------------Dist ance 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 reI6airing (describe)-----------------------------------'------------------------------------------------------------------------------.--------------------------------------- ---------------------------------------------------------------------._.------------------------------------------------------ ----------------•----------------------------------------------------------------------- ------------II_------------•------------------------- :. ill: -------------------------------------------------------------•----I•----------------------------------- --------------------------------------•-------------------•--------•----------------=--------------------------------- Thereby certify that I have prepared this appiication a. that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the Sari 'Joaquin Local Health District. A. :I�` is �0 , (Signed). ---------------------- ' ( r Contractor) ----- -- ---- Title F�8tm8LDr (Plot plan, showing size of.. , Iota+' n of system in relation tp wells, din s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------- ----------------- ------ //[[ DATE---------;---- REVIEWED BY------------------------------------ -------- xYC3 �� ----- ------ DATE------- -- ----- BUILDING PERMIT ISSUED.......------------------------------ -----------------Ili-------------------------------------------- DATE----- ------------------------------------ ----- -- --------- - Alterations and/or recommenda.tions:----------------- ------- ------------- --------------------------------------------------- •-•----------------------- a, 1----------• ----•------------------ ----------- --------.--•-_----- --------------------------•----•-----------•---------------- -- I -------------------------- =----------------------.-. -----------------------_---------------------------------------------------------------------------------------------- -•-------- ! I / FINAL-INSPECTION'`�BY. ____ _ ------- Date------`-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100