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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) --- ll, Date Issued . --- .- Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construe and install the work herein described. This application is made in compliance with County Ordinance No. 549. 3 1 F-S rr=v4^4_Cf>,,) r¢v E - r JOB ADDRESS AND LOCATION__- o- _-- -L � t ---bei,-j ad---4102---NPawtoxi_R��3�--- ��'n. Owner's Name-----E�.m-el'---L�.1.] ie Address------------ ---------------- -- Phone--- -- ------ 7..0. Contractor's Name_________2---�ekr t ---- --------•---------- - -----•------------------------------------------------•-----------------•-------------------------------------------- ____________ --•---------X41 _7C-•------------•------------ Installation will serve: Residence (2 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1---- Number of bedrooms -----2- Number of baths __-7..-_ Lot size __5Q-x-_� , Water Supply: Publics stem ---------------------- Y ❑ Community system ❑ Private (2 Depth to Water Table - - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam] Cla ft. Previous Application Made: Yes Y El Adobe E] Hardpan E]❑ No ® New Construction: Yes ® No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: 63 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -4� Septic Tank: Distance from nearest well------ 0--_--Distance from foundation--- f 1 iddep.th _.Material__Gement!-b_ric1,------------ ® No. of compartments 2 Sizerj_'.]�l =Y�l} Liquid depth- ` ' ' Ca acity.__�-C�QQ»�a Z�1 Disposal Field: Distance from nearest well-------5-Q-__Distance from foundation___ ' Top �C bot tom,, ® Number of lines_.-----1----------_-------------Length of each line_-__5p-- -�_---Widthcofttrenchnearest of line_-5-__._�'--_ . Type of filter materia ---of filter material___-,�..-----__---Total length___/ al------------------------ w�1p eepage Pit: Distance to nearest well-__--�.-Diafance;,fl-om4oundation_- Q_--_:__Distance to nearest lot line____._____---- © Number of pits.----1-_.:~---:----Liming material_,_azk- ____-':_Size: Diameter____ OK_.__ Depth--------'��L.---- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- material___----_---_---_---_ ❑ Size: Diameter --------------------V-- Depth------ -•-------- 4 -------------- ------Liquid Capacity---------------------------gals. �. Privy: Distance from nearest well-___________________________ ____---Distance from nearest buildin ❑ "Distance to nearest lot line - 9-------------------------------- -------- -- a Odell and/or r arrin describe):___-_ne-w----_- _ t-yt,2�{�' -- ---- ---- R --- - r -- -- ------- --- -- - - ---- ---' - ---------------- ---------._.-_- Va - ---- __ _______ _ _ __ ______.I hereby certify t I ed this application ----- ---- --------- ordinances, State la , and rules and re ulations oft a the �" will be ne in accordance wi Joaqui bun y 9 oaquin al Health District. (Signed)-----------del (Owner and/or Contractor) Of - (- - - -----------Title)----en_. �Tr [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 - ' DATE------- -- .,' REVIEWED BY----------------- -- } ----------------•---------------- a��--- --- - ------------ - -------------------- f / ---------------- BUILDING PERMIT ISSUED ------------------------------------------------------------------------ ----- --------------------------- DATE -------. DATE ------------------------•- Alterations and/or recommendations:________________________ ------------------- - ----- FINAL INSPECTION BY:---------- `sa <�_ 10 -( --------------- Date-------- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes} 0A Street 132,Sycamore Street Stockton, California 814 North 'C', Street Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-21DO