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i �Y N y jPPFICATION FOR SANITATION PERMIT'S y` Permit No. a_�_'Z..�... (Complete in Duplicate) ,xf Date Issued __*144/61 _� 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---------------222-5---1{o-tt-en---AV-,,----------------------------------------------------------------------------------------------------- Owner's Name--------------------JCUW-eY'_t---Forme-------------------------------------------------------------------------------------------- Phone----4-_$2.8-L------------=- Address------1630 harbor A=V r------------------------------------ Contractor's Name---------------------------------ae1 -a---------------------------------------------------------------------------------------------- Phone----3-_39.5-5-------•------ Installation will serve: Residence ER Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-2--- Number of bedrooms -----2 Number of baths -2 Lot size -50M20-0 Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table _35 I ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: Yes [] No ® New Construction: Yes ❑ No IN 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_______________-______________________-_______-_. f v Eii:orI,Lq- No. of compartments--------------------------Size------------------------------•-Liquid depth--------------------------Capacity---------------•------- Disposal Field: Distance from nearest weU-----------------Distance from foundation--------------------Distance to nearest lot line_-__________ ELLET i�„1 Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material ___--y-----------------Depth of filter material-----------------------Tofal length___________;______________________________ ie/ we 11 LLob!e. ab ned -- gity water is zn now r Seepage Pit: Distance to nearest we / Difrom ou ation_______�________..Distance to nearest lot line_________ _______-___Linin mat '_i_Qk_._____ ize: Diameter_-______Number of Pits 9 �� Depth 31I)Cesspool: Distance from nearest well__________-_____Dif oundaticn--------------------Lining material_________--_______________--•-_____. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------_---____. --------------------------- ❑ Distance to nearest lot line------------------------------------------------•---------------- ------••----------------- Remodeling and/or repairing (describe):_____1ar tall ing�--ri-ew---Y_ert_l.aal---dx_'. W-__a �....r1lo—o�-;i.�l?___uf?__1G?--.-_--:-:-- the---e x int ink_. _e�_t_i ��a�� =.�r.i_t�h. o_1id.., Ana---------- ----- - -- ---•-------------•------------------------------ -------- ------- I hereby certify that I have prepar9d this japplication and that the work will be d ne in accordance with San Joaquin County ' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----...................O.G ta----•-----•-----------`-` �-o-------- - --------- -- ,--- ----------------------- ------(Owner and/or Contractor) By:---------------------------------FParry--E art"IA: ------; ------(Title)----Qwnexm •i8n!----------------------------- (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can 6e placgd on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - DATE ------------------------------•----•--------------- REVIEWEDBY-------------------- ---------- ----- - - --------------------------------------------------------- DATE------ -------------------------------------------- BUILDING PERMIT ISSUED ----------------------------------------- --------------------------------------- DATE.------------ ------- ---------------------------------- -A- lt rat' ns apd/or rec mendat1ons:- - ----------•----------- - '� ------------ -- --- - - --------- ------ - --- ----- � ---------- .------------------------ t -- - --- --- - ------------ ------- - -- - - -- --------------------------------- - - ------------------- - -- ilk FINAL INSPECTION BY:----\Ji--V --------------------------- Date-------- � --------------------•- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Scree+ Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M B-51 Revised W-2100