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APPLICATION FOR SANITATION PERMIT Permit No. 6- -k---- (Complete in Duplicate) Date Issued ___!0 a 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• 5 JOBADDRESS AND LOCATION-----2-616---Z,---j�Dnona---------------------------------------------------------••-------------------------------------------------------- �`Arvzn Ta.� kersle 4-90].0 Owner's Name '.-•• --------------------------------- Phone Address----------26.08---Z-'----*om-r-a----------------------------------------------------------------------------------------------------------------------------------•-------------------- Contractor's Name--•----111 It_:a------------------------------------------------------------------------------------------------------------------------- Phone------may -3jc-- -- ------ J J,� Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ __ Number of bedrooms ___2__ Number of baths 2____ Lot size ---------50X11130----------_______________________ + 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 ® Hardpan ❑ Previous Application Made: Yes ❑ No El New Construction: Yes ❑ No ❑> 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________---_----_____--_-_______________________. ` ExIsC 116 No. of compartments------------------ -------Size--------------------------------Liquid depth--------------------------Capacity--------------•-------- 4 Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line---------------__ Ex is un Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material_________________________Depth of filter material-----------------------Total length------------------------------------------ N' Seepage Pit: Distance to nearest well---------------------Distance from foundation-----:2________....Distance to nearest 1 51----... { r Number of pits__________1---------Lining material______br__LQk__-Size: Diameter-----?•241-----------De th_,_, " Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. 1 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ E-1 Distance to nearest lot line--------------------------•--------------------------------------------------•----------------------••------------------•--------------------- Remodeling and/or repairing (describe):__-�T1�� 11lIIY� af__..0 �_-_(_1_}----SF __'.L . l--- C3�y .�_- irn.__tn--t-,h ---s;..1&L. ...tanks---',r__-th__aalid---2-Lde--------------------------------------------- ------------------------------------------------------•------ ----------------------------- ----------------------------------------------------------------------------------:-----------------------------------------------;----------------------------------------------------------- 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 +he San Joaquin Local Health District. ,A (Signed)------------------------------------D��,t,-a----------------------------------------------- - ---- - - - (Owner and/or Contractor -- ---------------- --------------------- IBy:-- ---------------------------------------Pe:ry =las -1 as -------------(Title)----QyUlie�-.l r-------------------------------- (Plot plan, showing size of lot, location of system in relatioro ells, buil Ings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- ------ ----------------- ---------------------------------------- DATE-------- ��_ -4---�=----------------- REVIEWEDBY-------------------------------------------------------------------------------------- ----------------------------------- DATE----------------------------------.-...-------------------- BUILDING PERMIT ISSUED-----------------------------------t--- - - ---- --_-_---_-.-f--J - DLA'TE :-----a--mss------------- ---------------- JA ----- _ --------Alterations and/or recommendations:.----- - - - -- -.__ - ----I r ---- ----- ------------------- > --a� ----------- ----------- ---------- - ------- FINAL INSP#CTION BY:-------fl�,I-- - ---------------- -------- ------------ Date-- ------� -- ` 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 1 ES-9-2M B-51 Revised W-2100