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�I C, rn- 1/ ` 5a. APPLICATION FOR SANITATION PERMIT Permit No. ......5-35 J. S+� 1 {Complete In Duplicate) t/sY' Dote Issued ..F.'(.7.4-3 Applieafion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ' 6 This application is made in compliance with County Ordinance No. 549. r77 i JOB ADDRESS AND LOCATION-' .Sherry"Road west•,off._ Sharps-__Im near. ---Tracks___._ Owner's Name^.--... ....._..... B-. Be81rd Company. I210. ........ Phone....... 133'Brid Plaoel Sto_kt.o_n, Cal.Address.---•-------•-----.........-- ----- $ _ Y_ Contrector's' �--- n - � ^ .. „ ------- Phone... � �.60.j--.._........_..; ... .............- -- -_ --"� '-------- Installation will serve: Residence ❑ Apartment House ❑ commercial-®-Tra;ler-Court-Q-Motel•❑ Other _ ❑ Number of living units: ........ Number of bedrooms .. ... i Numboyfbathsy:..4 Lost sine �..�._AcreB._._.,•.•_---__--._,•- - . Wafer Supply: Public system ❑ Community system ❑ Pfev'afa(N -Di'pth'to Water Telile 2-�-!ftr' Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ �jandy Loam E) Clay Loam ❑ Clay E] Adobe[I Hardpan E]Previous Application Made: Yes$] No F] New Constrr. ctid : Yes ® No ❑ (�,� TYPE OF INSTALLATION AND SPECIFICATION5:4 v (No septic tank or cesspool permitted if publ'Wta%ier ti ailable within 200 feat.( Septic Tank: Distance from nearest w IL_ :QQ�._Dista a from foundation...1J.�.._._Matetrial._._.. CQI1C2!6t.. -_....-----_ ® No. of comportments..... .....-___.__.Size..(3270.D. Liquid depth_...ZQ_..............Capacity.z50Q._G. Disposal Field: Distance from nearest well.400, r.-Ziston'ce.frumdqundation.._.._ s r 3 ........Distance to nearest lot line..._-_----- . lq Number or lines....2-........ .. Length of each - Width of trench...Z:14n........_............... :. e............ 19h------- - oo r Type of filter metanal._1 _S_OC1;C p p}� of filter matenal_..___....._J.__..Total length.__.. ..._._......_.......... I -- Seepage Pit: Distance to nearest well..,�......._.�.._Distance ftom•foundation..._......_.......Distance to nearest lot line--------------- - F-1 Number of pits......-'.._._......._Lining material..__........_.,......Size: Diameter.........._._...._ . _ Depth..._...._-----•-'•-•-- Cesspool: Distance from nearest wall......... ...i.Distanca from foundation....................Lining material........... ❑ Size: Diameter_.................................IIDepth__,, _...........Liquid Capacity_.._...._...__.__...gsk. - Privy: Distance from nearest well_..............1......_.__.........__...Mstence from nearest building ❑ ------- Distanceto nearest lot line...._......... ......__.....__.._._._..._......._-------- ....-......-'-.-"---........._.....-A_,_.-,__....__...._ , Remodeling and/or repairing fdescribe):...-........... yBtelll.._foP _nepT.•p. nt, to_se2'pQ25-._to .!*aJ-_-eFAploY-ees, I 1 --- ....._..-------......--....-...............---•-••x—tel- ........ - -.....-------.........................--...............-..........,_..........._......--------------•......------_---------------------`------------_-----_..........._..__........................ I hereby certify that I have prepared Als application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and -i gulations of the San Joaquin Local Health District. (Signed)........._Ba?.`.?'. Bhl.InCt--_-__ ------_-.-_.--.!__.--.-.-..-- -- - -- - _ - {Owner and/or Contractor) By:._..-----.._.......--------......._Mile-9iA .Parris -- �'�°1- Pre•eldent - -- - -........... (Plot plan, showing size of lot, "Non of system in relAmn fc wells, buitdy s;yta.,.can`be placed o n-r;ver3e side). i FOR RtPARTMENT USE ONLY APPLICATION ACCEPTED B ....._�...._�._.....-._......I DATE.�� REVIEWED BY--_- ...-----._------ _ .---- � -.._-----------------------••----.... ---......--........ ....... ..............._ _ ...._..... - - DATE..... BUILDING PERMIT ISSUED..-._.-.._..... ...._.........---.-- -- .. .-- DATE..-.-,. ------.._.._.-....-------.. Alterations and/or recommendations:-._�...-.._--..___. .................................._.—....._.-.._....._ ......._...__..........._.....-_..___��._. ----------------........._.........--..----..,.........,_..._..._.....-----.._...............__........_........_...._....-___.__._._....._........................._....... ..-. _....... ____.................__......__.._.........._........----............._..._......_....___.-___...__.........................._..--.....--�__._..-.._._......------ . '....------.....--.---..........^............ .................. - . FINAL INSPECTION BY:....--------... ......... ... ...i_..........- ---------- Date-__O-,l.- ......_------... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sheet 300 West Oak Str..t 132 Sycamore Streaf 814 North •'C'• Strad Stockton, California Lodi, Cefif...;a Me.+"A. California Tracy, California FS-9-2M 10-57 Revised W-2100