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z Permit No. ne APPLICATION FOR SANITATION PERMIT- _ (Complete in Duplicate) 3_-�.7-: P � Date Issued .__. Application is hereby made to the Son`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------- 994 S. Netherton------- . ----- Phone---n --------------------------- Owner's -------------------------- Owners Name___________________ ------------------------------------------------ - Addresssame ------ --------------------•-------------------------------------------------------------------------- - ---------------------------------------------------- Phone------- Contractor's Name----------------------- .....Ino-• +« Motel ❑ Other ❑ Installation will serve: Residence 'M Apartment Hbuse ❑ Commercial ❑ Trailer Court ❑ Number of living units: -1---- Number of bedrooms _2____ Number of baths __1___ Lot size ----5QxlZ5------------------------------- Water Supply: Public system El Community system ❑ Private ®z .Depth to Water Table 3C?-. ft• Character of soil to_a depth of 3 feet: Sand ❑ Gravel 171 Sandy Loam E] Clay Loam [I Clay ❑ Adobe [7� Hardpan El Previous Application Made: Yes ❑ No:C] New Construction Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: + (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------- ---------- EXISMING ' No. of compartments-- ----------- -----------Size.--------------------------- Liquid depth Capacity E I t Disposal Field- Distance from nearest well40-40 -_.Distance from foundation____L©-°-- ------Distance to nearest lot line_______------. ` i ® Number of lines- ------1----------------------Length of each line--------25�--------------Width of trench---_-2-�---------------- t4 Type of filter material__--____r.Q-Clk__---Depth of filter material_______--1.8_ -----Total length___2 __________________-------------- Type ___•----•--- Seepage Pit: Distance to nearest well---------------------- from foundation------------.-------Distance to nearest lot line______..__ . - Depth-------------------------------- _ Number of pits----------------------Lining,material----------------------Size: Diameter------------------- - - J Cesspool: L}istance from nearest well-----------------DDettahce from foundation_==.----------_-__Lijquid Capacity_._________________..____gals ❑ Size: Qiameter---'�-- -------- -------- --------- p 'f --------------------Distance from nearest building Distance from nearest well------------------------- --------- Privy- i 1Distance to nearest lot line----------------------------- --- Ej r - Remodeling and/or repairing (describe):_._-25:f't_ af---hQrizQntal---a fading------------- ----------------------------------------------------- I ------------- - -- ------------------------------ ------- -------------- -----I--------------------------------------------------------------------------------- --- . --- -- ----- -- ------------------------ ------------------------------------------------------------------- I- -------------- hereby certify sh and I have rules this application the San Joaquin the work cal Health e don can accordance with San Joaquin County ordinances, Statej ' -_---Delta_,-_-_ n .___-____-____ (Owner and/or Contractor) (Signed) G - - M� --- - --- ----(Title)-------- ---------G11A.-- r-4---- --------- ---------- By: ------- ------ sY:-------------••------------Perry- iWarthan-------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY,---- ------- - --- -- -------------------------- DATE------ --------------------- --------------------------- --- ---------------------------------------- REVIEWED BY---------------------------------- -- ---- ----------------------------- ---------------------- ------------------------ BUILDING PERMIT ISSUED----------------- - ------------------------------------------------------- ------------------•---- DATE_------------------------- -------------------------------- Alteratio s a /or reco mendations.-------------------- -- --- --------- 1 --•- - -- -------------------------- ------ ------- - �/ 3Ij _,_ ___ __-- ------ - -------------------------------------------------- f ---- ------- FINAL - d _ --------- ' INSPECTION BY:----------- -- -- ---- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycemore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y� ES-9-2M 10-52 Revised W-2400