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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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. JOB ADDRESS AND LOCATION--------212___S__.___Mader-a_______________________________ - --------------------------------------------------------------------------------- Owner's Name---•--------- X%.g----0-ja.uda---Dla 3.wee !!-------------- --------------- Phone 2-3 �------------- • - 7777-- -------------------7777-- - Address 212g -------------------------------- - 7� } --- ----------------•- -----------------------------------------------------------------------------7777-- Contractor's Name-----------De-It-� - - --------------- Phone-----3 � - - - ----- - -- 9 55 Installation will serve: Residence [-I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other EB ab irt;3 Number of living units: ----5- Number of bedrooms _� Number of baths _--_Q Lot size ----_5i?xi.50------------------------------------ Water Supply: Public system J] Community system '❑ Private ❑ Depth to Wafer Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑X Hardpan Q ` Previous Application Made: Yes ❑ NoX] New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well-----------------Distance from foundation------------------Material ------------------7777------- F-1 No. of compartments--------------------------Size--------------------- ---------------%3 -----Liquid depth----------- Capacity isposa Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line---_-------_--- _. ❑ Number of lines------- ---------------------------Length of each line------------------------------Width of trench k Type of filter material-------------------------Depth of filter material-----------------------Total length-------------------------- -- Seepage Pit: Distance to nearest well-__-1.00!7------Distance from foundation------41----------Distance to nearest lot line-- E?' Number of Pits--_---_3,-----------Lining material------br_J C. k_-Size: Diameter------------ ---- 14' Depth --- - - -----7777-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---___---__------__-_----7777-. ❑ Size: Diameter--------------------------------------Depth--------------------- ----- ......................Liquid Capacity ------gals. z Privy: Distance from nearest well------------ -------------Distance fromyneares}`buildin g ❑ Distance.to nearest lot line_.__�______________________________7777_____-__-_ . 777777 77-------- Remodeling and/or repairing (describe:._-__-ITaS_ � his---Plumher____iCLak._.up--tbe_ sinks---------------•---------___-•- -------------------------------------------•-------------------------•----------------------------------------- ------------------------------------------------------------------ ---------------------------------------- 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) ---------De.1t-a--------------------------------------------------------------- --- -------•--(Owner and/or Contractor) ------------------------------ -- - ------[Title)---OR LS ' - - - ----------------7777-- ---------7777---- ________________________ (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 - -----7777-- ------------------ 8Y ----------- - DATE---------x -----------------------------------------7777-- - PERMIT ISSUED---------------------------------------------------------------- ---------------------------- - - „�----------------------------------------------- BUILDING • -- -- --7777--------------------------7777-- --7777-- DATE E ------------- -------------------•---- Alterations and/or recommendations:-._.__�_----____7777________________ _ ------ -------------------------- -------------- -------------------------------------- ------ ------ ---- -777 7--7777-- - 777777 77-7777-- - -77 77---••7777-7777-• FINAL INSPECTION BY: ----•--------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oa1.k Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M 8-51 Revised W-2100