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_0 .� e 1 APPLICATION FOR SANITATION PERMIT Permit No. _._ ._ .� ------ (Complete in Duplicate) N Date Issued Application is reby 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----------------2022_-B.e11e--- V--:-----------------------------------------------------------------`-------------------------------------- Owner's Name--------------- 2.SI__BlackweZl-------------------------------- ------------------ ------------------- ---------------------- Phone-----n4------------------------- Address-.......... ame---••-----.-- ------------------------------------------------••-----................. Contractor's Name----------De_Lta_,____I c----------•-------------------------;---------------------•------------------------------------------- Phone----•7_— Installation will serve: Residence :] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_'3___ Number of bedrooms ___4___ Number of baths ---3-, Lot size .___-_50X20Q________________________________._ Water Supply: Public system ❑ Community system ❑ Privatef] Depth to Water Table _3,(L 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 ❑ No:c] 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---------.-_________._.________-___._...______- exIq,tng No. of compartments------------- ------ -----Size--------------------------------Liquid depth--------------------------Capacity---------------------- i Disposal Field: Distance from nearest welL5O_=--------Distance from foundation__ 'Q RJ to nearest lot line--- ---------- ]® Number of lines----------I----------------------Length of each line-----_40------------------Width of trench.-----2.1 ------:----------_-.--- Type of filter material )rOCX_-------__Depth of filter material____18 .-,.......Total length__________40_°________________________ 0 _Distance from foundation____-_ 0 r. 1' Seepage Pit: Distance to nearest well_ �__ ____._.__ � _ Distance to nearest lot line_________ _____ ( Number of pits------1-------------Lining material_br' Ck------Size: Diameter---�-�--------------Depth----------15................. 4 Cesspool: - Distance from nearest well-----------------Distance from foundation___-----------------Lining material------------------------------------- Size. _______.__-_ .___.______- Size: Diameter--------------------------------.----Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------"_:---------Distance from nearest building-----.------------------------------------ fl __- _-----____________._____..__.❑ Distance to nearest lot line-------------------------------------------------•--------------••--•---------------------------------------------------- Remodeling and/or repairing (describe):--------hor.LZental---ant---lea.ch------an3---3-_'x15'_.__vent------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ ----------------------------------------------------------------------------------------------------------------• ---------------•----------------------------------------------------------------------------------- ------------•-----------------------------------------------------------------------------------------------------•---•----- ----------------------------------------------------- ----- - 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. T?el t pt.. --Irn0--------------- ,-- (Signed).---------------------- ----- -- -- - - ----------- -Q--------- - - - - -- (Owner and/or Contractor) r ------------------ --------------------------------- --------- ----- - --- By:--------------Zer-ry..'-__WF_r.t-�1-n---- = ----------------------------------------------------(Title)-- G_en..----Mg-r'------------------- ------ (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 BY --------------------------------- ------------------------------------ DATE BUILDING PERMIT ISSUED----------------- ------------------------------• DATE-- ------ ----------- Alterations ---Alterations and/or recommendations:---------- ------------ ---------------------------------------------------------------------------•---------.-------- ---------------------------------------- ----------- ------------------------------------------------- . f -----------------------------------------------------------•- --------------------------------------------------.-------------------------------------------------------- --=--------------- --------------------------------- / a)`6zG,j1, - q13� s .- FINAL INSPECTION BY:.------ - ---------------------------- Date-- - -------`� ------- ---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street., 814 North "C" Street f Stockton'.California Lodi, California Manteca, California (racy, California y ES-9-2M 10-52 Revised W-2140 ,�