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- v _ APPLICATION FOR SANITATION PERMIT Permit No. ZCI.!9��..`!F----.- �' (Complete in Duplicate) f � �. 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. JOBADDRESS AND LOCATION-------1935----Es---- 4h -S . z---------------------------------------------------------------•------------------------------------------- 4-8628 Owner's Name--- JOla----aTld-A&TI---lllri'x3 Radr3 ue ------------- -- ----- --------------- ------- ---------- Phone--- HO.------- ------------ I Address------------------------------- ------------------------------------------------------------------------------- --------------------------------------------- Contractor's Name----------Deft_&_.0P Uq--- -------------------------------------------------- Phone.H9---- 77--'- 7---- Installation will serve: Residence [X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel D. Other ❑ Number of living units: ___3. Number of bedrooms _-3-` Number of'baths --- Lot size -------- 0-X-1Sa---------------------------------- Water _______ _________________________Water Supply: Public system Ek Community system ❑ Private ❑ Depth to Water Table43_--_ ft. 1 Character of soil to a depth of 3 feet: ,Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IN Hardpan ❑ Previous Application Made: Yes ❑ No [2 New Construction: Yes:K] No ❑ FHA/VA: Yes ❑ No:C] 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-------------------------------------------------- Existiig No. of compartments--------------:---------- Size--------------------------------Liquid depth-------------- - ---------Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line____________-_-- Existuig Number of lines-----------------------------------Length of each line---_--------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length________._________--------__________-__ Seepage Pit: Distance to nearest well----10____._______Distance from foundation-----1fl------..Distance to nearest lot line-5 ----------- :K] Number of pits----------------a,----Lining material_____x'OC4------Size: Diameter-------33_u___...___-Depth___._25_ ___-______-_---- . Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------------.-_______ ❑ Size: Diameter---------------------------- ----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--- ------------------------------------------Distance from nearest building------ -----------------------.__.._------ ❑ Distance to nearest lot line-------------------------------------------- -------------------------1-------------------------------------------------------------------- Remodeling and/or repairing (describe}: bLdd Ti 8PB a --- ---------------------------------•-------------------------------------------------------- - - Pte_. p _ " ------------------------------------ --------------- -------------------------- -- - - - - -- - --------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. (Signed}____._-Deft__ ---S?� --T-mak--Servicesn ' ' (Owner and/or Contractor) ---------------------------------------- ------------------------- +1 : By:...---P�X'T'Y �a!".th�11------------------- -------------------------------------------------------- -----(Title)--Gen---------s- I- gr---------------------------------------- - - (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------------------------- DATE_- -- r) / -a------- BUILDING PERMIT ISSUED------•---------------e _ DATE-------- --------------------------------------------------- ' Alterations and/or recommendations------- ------------ ------------ --------- ......... -------------------------------- ---------------------------------------------------------------------------•---------- ------------------------------- ---•- -------- -------------------------------------------------------------------------------------- ------------------------------------------------------=----------------- ---------------------------------- ----------------- - --------------------------------- ------- ------------------------------------------------------------------- --------------------------------------------- FINAL INSPECTION BY:. _ ✓� -- --------- - - ------------------- Date--/----"-- ------ --------- 7------------- --------------------------------- SAN JOAQUI 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 ES-7-2M Revised 1-57 F.P.CO.