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APPLICATION FOR SANITATION PERMIT Permit No. '02-j-4--o----_ ell [Complete in Duplicate] ; ` ? "�, Date Issued fW'_/-�'.`r� 6S ZeL f3 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. '2..303 S-„IW- pq--aI-CVrd s 7-7{ West side JOB ADDRESS AND LOCATION---2nc1--_IousM---ScLut.h---oF---ath.__St.....on---aoiith---Mad1wn__-fit.....fly'_.-M.-Ld3son, Owner's Name----------------Harry---Way Shyna------------------------------------------------------------------------------------------ Phone------.3-1624------------ Address----------------------------2129..•3.0_x---Madtaon-3t- --------------------------------------------------------------------------------------------- -------..-_.-._..-.---- Contractor's Name------- �. fit_._ � rr� & 5.0113s---1xC*_._. .-. . .- A---------------'- '---- Phone-9-96Q7----------------- Installationwill serve: Residence [M {Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1*_ Number of bedrooms _2*_ Number of baths ----I*Lot size _ DCt_1X300_1------------------------------ Water Supply: Public system® Community system '❑ Private ❑ Depth to Water Tab ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan �+ � Previous Application Made: Yes ❑ No$$ New Construction: Yes M No ❑ 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.Ro le._---_Distance from foundatioU.................Material-------C---C.__Rx'J.-Ck-___---------« i No. of compartments------2-----------------Size__j:$ftft,5611X3_ 1Liquid depth---X41 --------------Capacity_.12Q0____-----_ Disposal Field: Distance from nearest well---Norie---.Dips't�nce om�oundation12..............Distance to nearest lot line-2D-1-------- �* Number of lines------1--------------------------Length of each line-_75'---------------------Width of trench__2_4_----------------------- Type of filter materialLk'----13k--------Depth of filter material----1_6f�------._.___Total length-------75--------------------------___ Seepage Pit: Distance to nearest wellO.rie----_-----_-Distance from founclationfl l----.----...Distance to neares nej6 ---------- xx Number of pits-----I--------------Lining material.CC------Brl.dze: Diameter-----42"----------Depth-- 1b-` -------------------- .0 , Cesspool: Distance from nearest well-----------------Distance from foundation---------.----------Lining material,---__.-_---------------_--_-_--__- ❑ Size:•Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gall Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---_--- ___--__- --- ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------ i Remodeling and/or repairing a,(describe):-*T'x' -sent---units-- - -------iz...de.tM d---a Ut-o....to... m -haz�diki---futux9---1--- o-drQ_Qorl-- nQt to �xece 3---unita--af----s-u-ch,.----------- --- ------------------------------- ---------------------------------•----------------------------------- ----------------------------------- -------------------------------------------- ------------------------------------------------------------------•--------•-------------------------------------------------------------------------------------------------- ' 1 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). D A P ---- d' �,'OPu3----lNC---=------------ -----(W� Contractor) f By: i�-� {Title) 1C�K` (Plot plan, sh Ing size of lot, location of s tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYE------------------------------------------------------------------------------------------- DATE_ REVIEWED BY DATE -- BUILDING PERMIT ISSUED- -__--- - ____---- DATE-----__---.___ ------. ---. . ti I f--------------------------------------- Alterat ns d/or recommendA f� '- ----------------------- ----------- -- ------- :--------:___-_____.---__:___-__::_f --------- :.__-_:_________--_-•--- ----------------------------------- ----------------------------------------------------------------------------------------------------------------------- ------ ------- - ff FINAL INSPECTION BY:----J . Date------------- ----- ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100