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Permit No. _ 6-- - Y APPLICATION FOR SANITATION PERMIT / (Complete in.Duplicate) Date IssuedI_'3'�' / Application is hereby made to the San Joaquin Local Health District for a perm; t construct and i t heher �• This application is made in compliance with County Ordinance No. 549. '{/" JOB ADDRESS AND LOCATION-------------------------------------------------- 3-}-- BDX P7 A7 IF fOwner's Name------------------±'-0mmY- �x---Kat_Z_aki�------------------------------------------------- Address ------------------------- - --------------- Phone----`Ls'-6-04-O-------------- --------------------------------------------------•----------------- ---------------------------------------•------ Address-----------------��'-'----�-s----�[�.Y�._#�'��-----------------------,---------- _ - Contractor s Name--------- -� t�-----=--•-----•-•-------------------------------- -------------------- ------------------------------- --- Phone-_3=39-5-5-------------- Contractor's will serve: Residence Q- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3 Number of living-,units: __1-__ Number of bedrooms __3--- Number of baths 12__ Lot size __2__&-_9/10- 'aar-e-S------------------ f i Water Supply:. Public system ❑ Community system ❑ Private Ea Depth to Water Table -------- ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam [❑ Clay F] Adobe[I/Hardpan ❑ it Previous Application Made: Yes ❑ No ❑K New Construction: Yes ❑ No 12 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-----------------------------:_-_________---____ -Sie--------------------------------Liqu;d depth--------- ----------------Capacity----------------------- EX LU ING -------------•--------EXIlVG No. of compartments . `fig Disposal Field: Distance from nearest well----------------- from foundation____________________Distance to nearest lot line------------------ EXMINGNumber of lines-----------------------------------Length of each line-----------------------------Width of trench------------------------------ --- y, Type of filter material-------------------------Depth of filter material------------------------Total length-----------..--------------I-----------•.- Seepage Pit: Distance to nearest well------X400--------Distance from foundation____10----------Dis ante to nearest lot line_.___5----.-. Size: Diameter----- -`b_--Depth---------- --- Q Number of pits Depth material_roCk------ 25 Cesspool: Distance from nearest well--_______--_____Distance from foundation-__________________Lining material------------------------------------- Cesspool: ___________ --____---_______•sls. ❑ Size: Diameter_ -. _Depth - - --- _ Liquid Capacity g ., � '�-� !"' Distance from nearest building Privy: Distance from nearest well --------- ------ ------------=---------------------- -• Distance to nearest lot line------------------------------------------------ ------------------------------------------ -------- -------------------------------------------------------------------------------- { i �,�.ix3. __n W__u � _ 1__dr_ain__ Remodeling and/or repairing (describe)-------------- i filter-rock_ dr led 4 � •. Q.:- ani_Ax l--_no_t_:�aver---25 f_t.x ----------------------------- -------------------------------- - -- - - ------- -- --- ----- -- ------- -------------------------------------=--------------------:-----------------------------------------------•------------ 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 Healt District. � � ------ (Owner and/or Contractor) (Signed)--- --------- By--•-----------------------FeS_r' _.. Ihan ----- ----- -----Title-------->Du��3e 'I��-�------- ----------------- (Plot plan, showing size of lot, location of system in rela#' n f wells, bu dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE------------------------------- --------------------- _ APPLICATION ACCEPTED BY------------- ------- --- --- --- ----- ----- REVIEWED BY-------=--------------------------- --- - - --- DATE w BUILDING PERMIT ISSUED------- ------ ---- ------------------------------------------------------------------ - DATE------ i - - - Alterations and/or recommendations------------------------------------ -----------------------------••-- -------------------------------- ----- ---------------- 1 -------•----------------------------------------------- -----••------------- � "d �� 1--------------- ------------------------- FINAL INSPECTION BY:--/ Date -------------------- --- � .. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California Stockton, California A R ES-9--2M 8-51 Revised W-2100 ri '