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r APPLICATION POR SANITATION PERMIT Permit No. (Complete in Duplicate) /2 Date 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. 549. JOB ADDRESS AND LOCATION----•-----------------1Q19---N_a.___S_Qha.61____________________•-----------__ Owner's Name-----------------Deam_Narria----------------------- -------------------------------- -----------------------------------------------Phone----2=-0-3��-------•------- Address--------------1019--- -' lQQ1- ----------------------------•--------------------------------------------------------------------------------------------------------------------------------- il Contractor's Name.-•--------- --------Dalta--------------�---------` ------------------------ ----------- Phone---_3_--'y55.--------- Installation will serve: Residence � Apartme Apartment House .❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units. __1___,Number of bedrooms --I--- Number of baths ._� Lot size -----50x150-----------------------------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(j Hardpan ❑ Previous Application Made: Yes ❑ ¢ No ® New Construction: Yes ❑ No [�j 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______ EX IV ING No: of compartmems--- -----------Distance from foundation_________ ---------Materia 1------------------------------------------------- ------------ Disposal Field: Distance from nearest well_________--------Size--------------------------------Liquid depth- -----------------------CapacitY----- ------------------ __ _______Distance from foundation-----------------.__Distance to nearest lot-line_-_..___---__-... EXI T'TNG 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 X_---------Distance from foundation----- ------------Distance to nearest lot line_-___-5.1______ KI Number of Pits-------1---------_ Lining material- Diameter---Size: Diameter---____ �--------__.Depth---------- 5-t-------------- Cesspool: Distance from nearest well------------------Distance from foundation_______________ i Lining material ❑ Size: Diameter--------------------------------------Depth--------------------- ---- ---------------Liquid CapacitY-----------------------------gals. J Privy: Distance from nearest well_______________________ _________________________Distance from nearest building____________________._ Distance to nearest lot line_______-.__________ Re neland/or {fdescribe):---------- _ - ° = a ° onlo � -------- --- ---Liney and bodkin uP ------------------------------------------•-----------------------------•-----------------------------------------------------------------•---- ----- - --------------------------------------------------- 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 Healt istrict. - r . (Signed)-----------:Q.e-lt a_..---------•------------- ---- ------- -------- --------------__--__ (Owner and/or Contractor) By: �' Y'Y' - ax- ------ ----------(Title)--Q%me rITtMGr (Piot plan, showing size of lot, location`of s em in la 'fn o wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ �-r__:- ►,__---_ DATE ------------------------------------------•---------------------- -- � - REVIEWED BY -------------------------------------------- ------------------------------------------------------------ --------------------- DATE--------- --------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------- -- -----------,_ DATE-- -------------�/-------•------------- ----------------------- Alterations and/or recommendations_ ______ _ ____ _--------------------------------------------- ---•---------`- :. ---------------------------------------------- ---------------- FINAL INSPECTION BY: - --------•------- Date- ,.. SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street f300 West Oak Street 132 Sycamore Street 814 North "C" Street � Stockton, California Lodi, California Manteca, California Tracy; California ES--9-2M 8-51 Revised W-2100