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/5�, ' AP�PUCATION FOR SANITATION PERMIT Permit No. ....�,7-.......... f (Complete in Du Duplicate) Y p � Date Issued ..- m Applica*ion is hereby made to the r'an Joaquin Local Health isiriNor a permit to construct and install the work herein described. This application is made in complier wi hQounty f�r�No. 547. LOTS 5 C/V JOB ADDRESS AND LOCATION-_ - - - - ---- ------ w `" ----------- �-2 Owner's Name----R!ta---Bonafiz1 =' ---- ----------- Phone---------------- ----------------•-- Address----------------------------------------------San---FTariQi.S.CQ.------------------------------------------------------------------------ ------------------------------------------•-•---- b John Mara_schino---------- Phone-----•--------------------------- Contractor s Name------•-Y•-•-- ...-••----- - -- Installation will serve: Residence IN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1-.-. Number of bedrooms ....I Number of baths -----1_ Lot size ;g.au-------------------------------- 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,r] Hardpan ❑ Previous Application Made: Yes a No ❑ New Construction: Yes ® No ❑ 7 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 -'nQXke---Distance from foundation---1.0------.---Material-----�;CnC1'.@.�.Q..................... ® No. of compartments------,2-----------------Size---6—2x—�-------.-------Liquid depth----5--------------.----Capacity---800------------ Disposal Field: , Distance from nearest well..nOlae...Distance from foundation---- ---.-.....Distance to nearest lot line.-5..-0, v ® Number of lines---312..:,x_;_: *x....--.---.-LengthRof each line-----3-�}--- �Q----.Width of trench------------------------- Type or filter matenal__S.T.e$QCkDepth of filter matenal_._la-------------Total length-------6.0.....-..--...__,- -- i ' Seepage Pit: Distance to near e st well_TI,On6---------Distance from foundation------15--------Distance to nearest lot line..-.- ! Number of pits........1 M- ------Lining material.--b1?1Ck_...Size: Diameter-----.. .!.----------- Dept h....2 Cesspool: Distance from nearest well-------- -s---.-Distance from foundation------------------- Lining material--------------- 0 Size: Diameter.-------------- - ------------------Depth------------- ----------------- - --------- ---Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------4-----------------------------------Distance from nearest building-------------.-..-------...__-.-.._.-.-.. ❑ Distance to nearest'.lot line-------- --- ------------------------ ------ ----------------------------••-•--------------------------------------------------------------- Remodeling and/or repairing (descri4 ;)'------ --------------- r --------------------------------------------------- S .. -------------- --------------------------------•------.-_--------------..__..------.._ w--..-.....-.-...•._.......___..-..__....._._...._.__.......-............-.__.........-........._....----........__---------------. .. v_ v ...............................................................................................•--........._....-------...._---........--..-._....-.-_-_.._.......__-_....__-..-.-....----..-.-----.-------...._..._...------- 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., y and or Contractor (Signed) ------------------- ----- --- --------------_ --------- BY� ----------------(Title) s (Plot plan, showing size of lot, locati of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- - - --------- ---------------------- DAT E------------ ------- REVIEINED BY -- -- ----- - ----- DATE m---------- ---------------------- - ------------- - BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE..------------------------------------•---- ------------ --- Alterationsand/or recommendations----------- ---------------------------- - -----------•----------------•-----------------------------•-----------------•-------------------•-----•------------- ---------------------------------------------------------------- ------------------- -------------•---------------•---------------------- -- -- ---- ------------------------------------ �} a ��... FINAL INSPECTION BY:...--?- -� -- f Date- ��" = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Americen Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca. California Tracy, California E5-9-2M 145446 ATWOOO 12.54