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(J APPLICATION FOR SANITATION PERMIT Permit No. 01 2 y (Complete in Duplicate) t p 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. 549. JOB ADDRESS AND LOCATION--------______233So. Windsor - - ------------------------------------------------------------ ---------------------------------• - Owner's Name--------------------- Seledonto Sanchez 3 667 Address.. = Same ----- Phone 4 Contractor's Name NX PARR TS H T NC., --- - --------------- ----- ----------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .---_ Number of bedrooms ___Z_ Number of baths _1--- Lot size ____75?__-x-__100 T-------------------------- Water ----__- -_Water Supply:. Public-system A Community system ❑ Private ❑ Depth to Wafer Table 40--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IN Hardpan ❑ Previous Application Made: Yes ❑ No EX New Construction, Yes N 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 wellNO ------Distance froM foundation_. ._1��------Material CC_-B A-0-k lE ®. < No. of compartments______ ________c_______SizeS�_ X 6Liquid depth------�g---- ____Capacity X00_--Gals Disp'osa! Field: Distance from nearest well---�g04IP_"_Distance from foundation____0--_--_--___Distance to nearest lot line___•5t__.__.. ® Number of lines------------------1--------------Length of each line-------�4 ________-__---Width offrench-----2�_'n------------------_--- Type of filter material_ it__ k_____Depth of filter material-_____18" Total length---------3Q. ------------------- Seepage _________Seepage Pit: Distance to nearest well-_None---------Distance Distancer m four_. _ ation------�Q_....... Distance to nearest l2 e p Number of its_____ ______________Linin materialCC_____-__._________-_ Size: Diameter_____ . " Cesspool: . Distance from nearest well------------------Distance from foundation--------------------Lining material-____________________________._______.l V'1 ❑ Size: Diameter -----------------Depth----------------------------------------------------Liquid Capacity --------------------gals.L Privy: Distance from nearest -----------------Depth from nearest building---------------------------------------- El Distance to nearest lot €€ne Remodeling and/or repairing (describe):---------------------------------------------------------------•-------------------------•--------------- ------------------------------------------------------------------------------------------------------ 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 +he San Joaquin Local Health District. Ri H IN G i (Signed)-----------•------------•-•- - - ° - - - - - ------------ - (�`��r Contractor) By:-- - - (Title)----- E 5-t 1-ma fo-------- (Plot ----- --- - -- ----------- --- -------------------------------------- ---------- - - ---------------"----- plan, s wing size of lot, locat' n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- ----- -------- ------ --------------------------------------------------- DATE--- --,�'_"_,T/___�-=_"s__-��-�-�='•"'.� REVIEWEDBY--------------------------------------------- --------------- -- ------------------------------------------------------------- DATE - BUILDINGPERMIT ISSUED------------------------------------------------------------------------------- ------------------ DATE- --- ---------------------- Alterations and/or recommendations:------------------------------------------------------ ------------------------------------------------- •____-- ----------------------------------------------- -------------------------------------------------------------------------------------•------------------- -------------------------------------------------------------------------------------------------------- ------- ------------------------------------------ 3 -- ----------"----------------------- -----------------------I----------------------- ------------------------ { FINAL INSPECTION BY: elu�. : --------------- -------------------------- Date. 1 � i_Y' ai SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 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