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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Permit No. -----.� 1117 i I this Permit Ex ires I Year From Date Issued ' Date issued ___.__ ' Application is hereby made to the San Joaquin Local Health District for a permit to construct This application is made in compliance with County Ordinance No. 549, and install the work herein described- JOB ADDRESS AND LOCATION _ Owner's Name------- - 4. A._J9tehw_e_ St- Fi •- t-- 20Stkfn cher Address #j j -- ----- �--- ----- ----- --------------------�---- Phone---H©'-- 2-» Contractor's Name D�Ztt S ----•-•--------------------•---------•---- r ------e-1°tc" Tank Service ------------------ Insfallafion will serve: Residence ----InC. Phone_._HOs. ® Apartment House ❑ Commercial. f Number of living units. _I ---" Number of bedrooms -" 2 Trailer Court ❑ Motel ❑ Other ❑ + Water Supply: Publics stem Number of baths -�- Lot size ----_--� Y ® Community system . ❑ Private ------------------- Characfer of of soil to a depth of 3 feet: {Sand ❑ Depth to Water Table .5-- ft, Previous Application Made: Yes ❑ Gravel ❑ Sandy Loarri ❑ Clay Loam 0 Clay ❑ Adobe [7� Hardpan ❑ � ❑ No [A New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Dist ana Septic Tank. . nce from nearest well------------------Distance from foundation________" &XMating No, of compartments___--- --•------ Material "-"--_-" Disposal Field. Distance from nearest well _� ---- Size-----•-•---------- Liquid depth-- --------- ---- ----.Capacity--- E--- --- s Distance from foundation___"]-Q-_---------Distance to nearest lot line____s�_r-_ " �pstin Number of lines _"_____- T Length of each line______-- ___ ype of filter materi�- Depth of filter material_."-"1 1---------Width of trench_ P --:,�------------------------ Seepage Pit: Distance to nearest well _ni]---"_ Distance from foundation_-_-- Total length_____-_ Number of pits__-"_ ---- -Q -_.--Distance to nearest lot Cess ool: I --- ---Lining ma#erial"--�.0_cX ____ Size., Diameter___._"-" " � 3"-______ Depth- _2 p Distance from nearest well _-"-- Distance from foundation__-----------------Lining material__""_- ._-" Size: Diameter".--._-" Depth----...__ Priv -- ---------- -- ----- ---- ------------,Liquid Capacity - ---• ry, y' Distance from nearest well- -------------------------- �' ----------- -------gals, ❑ Distance to nearest lot line---------------- Distance from nearest buildin Remodeling and/or re airin + -- ------ `� p (describe): adding. $-�'pp�gA_'_+_i _ - -------- ----------------------------------------------- hand"-basin- P.__ _-_tR_ .axis-ting__.se-ptc for shower, " - - d k--t chen $ink---- y---------------- •---------- -------------------------------------- ----------------------------- ------------------------= ---------- 1 Ihereby certify that I have prepared this application and thatlhe work will be done in accordance with San Joaquin Count- ! ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 q - Y I (Signed)-------- Septic- T-arik" �,.�..`.�....,.. 8r Perry Warta --""_- ----------------(Owner and/or Contractor) = Title Gen (Plot plan, showing size of lot, location o s in rel i n to wells; buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - L -REVIEWED BY - --- --- ------- -------------------------------- DATE ' BliILDlNG PERMIT 15S�IED------------------ -- -- ------- _ DATE------- ---- -----•--...--- - ---------------- - aerations and/or recommendations---------------"_-" - . ----- ---------`-------------------------------------- DA•TE___"_---"_-"--_---"--- " ---- - .- ------•----- - -- ------ ------- -----------------------•--...... --- ---------------------- ------------ ------------------- FINAL INSPECTION BY:":- _" l- --------------- --- Date_ - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American `Street ' - 300 1Nest. Oak.Street 132-Sycamore Street Stockton, California Lodi, L`alifornia 814 North"C" Street. ' ' Manteca, California T Es-9-2M Revised s- 9 raey, California '