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I { A APPLICATION FOR SANITATION PERMIT Permit No. k � (Complete in Duplicate) iV NN �A I7 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, 54.9. JOB ADDRESS AND LOCATION-------- 2465 M st]eDe ------------------------------------------------------------------ ---- ----- ---- ------------ ----- Owner's Name-----------------------------U—Qyd..De--- -------- --------------------- -------------------------------------------- Phone__3_!7R6_5_0 Address-----------------•------------------------246 ---Mistletoe---: Contractor's Name-----P_..... .--_P 3'2'ish_&--Sons-,__ ane-._ ------------------------------------------------ Phone------9`-96-0-7------ y Installation will serve: Residence E 'I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_--1__ Number of bedrooms ---2__ Number of baths ___1 Lot size ___----?�Q_ R-•-10 Water Supply: Public system ZJ Cornmunity system ❑ Private [] Depth to Water Table _-yo ft. �f Character of soil to a depth of 3 fee+ Sand ❑ Gravel ❑. Sandy Loam ❑ Clay Loam n Clay ❑ Adobe [0 Hardpan ❑ Previous Application Made: Yes ❑ No [X New Construction: Yes g] 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-----------------Distance from foundation-------------------.Material ________________-_____---_-------__-- --___ --- No. of compartments ------ -----Size-------------------------------- depth--------------------------Capacity Disposal Field: Distance from nearest well------------- :_:Distance from foundation--------------------Distance to nearest lot line____---_______._. ❑ Number of lines---- •------------------------Length of each line-------------------•---------.Width of trench------____-_------•-----___-- Type of filter material______________________ __ ---- Depth of filter material_______________________Total length-____,_----____---_._- i ---------•--------- See age Pit: Distance to nearest well----�TQ2'}.e Distance from foundation__8_._ft. s__.Distance to nearest lot line_20---f * ij Number of pits----1 Lihgmaterial__C _ - --� _ 'z e: Diameter-------33 i1-.Depth-__-_______3�--f______________ n Cesspool: -+----- Distance from nearest well_------------- Distance from foundation-------------- --.Lining material--_-_--------------___.---_.__-__ .._ ❑ Size: Diameter------------------------------------ Depth---•-----------------------------------------+-----Liquid Capacity-•--------------------------gals. Privy: Distance from nearest well---------------------------------- - -------------Distance from nearest building---------.------------.------_---__.__--... 3� ❑ Distance to nearest lot line----------- --------------- Remodeling and/or repairing (describe')---------------------------------------------------------------------------- ----------------- ----------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ 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+-,: pax' l_k� 8c-S ons -r --T------------ + --------------------------------------- ----------------------- Contractor) 15 P/�- ' -------------------- ------ -- - ----------(Title)----�'-S.�1J��Q�-------- -------------- {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-----------•__-_ . �r - ------ REVIEWED BY-- ------------- -------- ----------- ---- 115- U f�- ---�; - - -- ----- ----- ---------- DATE BUILDING PERMIT ISSUED ------------------------------------------- ---------- DATE------------------------------------------------------------- --Alterations and/or recommendations:___ ----------------- -------------------------------------- ------------------------ ------------ -- - - -- -------------- ------------------------------------- .9 �... r i FINAL INSPECTION BY:_ -_ - --,-- - Date--- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" freef Stockton, California S Lodi, California � Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 y .