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APPLICATION FOR SANITATION PERMIT Permit No. (Complete-in Duplicate) ` Datel Issued Applica+ion 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. s 'I .Just• South_of Hand e1I S Home JOB ADDRESS AND LOCATION------About--1--mi1 -,yreo --qf.. a( f� o_Road c 1f1 o©tb Owner's Name---------M --j-*--35' k. ---------------------7�--------------------------------- - Phone'- Address _G �? e j Calf-,--.. - : j �`=` -------------------------------------I Zod1 0 2 Contractors Name---- E_r___Dattibac _ _ ----------------------------------------------------------- . , --- Phone �o -4 ± -------- -•-----BQme.__ Phone_ Tho_rnton__;5 Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ y Number of living unifs:,___.1_ Numbef.of bedrooms .3---- Number of baths -_4_- Lot size __-_- .,`C)s!__ir'T-t-:_ ?r _tc1ee _____ Water Supply: Public system •Community system ❑ Private f] Depth to Water Table Character of soil to a depth,of.3 feet:,'Sand ❑ Gravel ❑ Sandy Loam ] Cla Loam Clay [] s y ❑ y ❑ Adobe❑ Hardpan ❑ Previous A lication Made:"Yes MNo PP ❑ ��[] New Cons#ruction: Yes �' -No El TYPE OF INSTALLATION AND,5PEClFICATlONS• f �t (No septic tank or cesspool permitted if public sewer is available withinn200,feet.) Septic Tank: Distance from nearest well_-_` 1-_---=D'istance from,foundation-----_1Qt-------Material_--COrzc ete___trienfOrCcd) L3No. of com ertments.-_--_2_.___- 2 Tanks ��_ p Size = Liquid;depth- t -Capacity- 15QO-eac�i' Disposal Field: Distance €rom nearest well__.--:-`-----.'Distance-fro n foundations __:4--- }o nearest lot line----------------- 2 Fields Number of lines-----3----------------------------Length of each line------70-!---- --_-_---'-•Width of trench'�-_Z4"-------• Type of filter material- - _1[_2;� xC{� }h of filter material----]2i'-__.__-_ ...Total length----2.Q1__----.. ; -------------•------ Seepage Pit: Distance to nearest'wall------------------ ---Distance from foundation-.--_-_-__....__--.Distance to near�st lot line.___----__------_ ❑ Number of pits----------------------Lining material---------------------..Size: Diameter- r --------Deptlh--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation----------------}-.Lining material_i`l-----------------_----.-- Size:.Diameter = = De nth_- "` __ `.. 4 -y `` p -------------- -------- Liquid CapacitYl` gals. Privy: Distance from nearest well------------- -- ---------------------------------Distance from nearest building- ❑ Distance to nearest lot line = :.! 4--------------------------------- # F i t � •------•------------------ --------- Remodeling and/or repairing (describe):.__--.._-_--_---.- II ----------- -------------•-------•-- -----------•---------•----------------•-------- ---------------------------------- I •� , f ll ------- -------- --------------------------------- -------------------------------•----- --- _. PP r ! herebycertifythat I have prepared this a licatran'and tlt - -- ---- --- ------•---------- ----• ---- - -------•- -- ----- at 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)-- L.f� __lar -' Z i i By:: --------------- (Owner ) -- �.. n r Contractor _--- -. _- -- and/or Y� = --------------------Title (Plotplan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ---- -------- --------------------------------------------------------------------------- DATE------.... -------------------- REVIEWED BY-------------------------------------------- ------------------------------------------------------------------------------ DATE---------•---------_---- BUILDING PERMIT ISSUED----------------------- ------------------ --- DATE Alterations and/or,recommendations:------------------------------ •• = -----•--------- -----------------rr------------ -•------------------------- ------ ------------- -----------••--------• - - ---------•------------------------------------------------------- -•---------------------------- -------- --------------------•--------------- -------- -------------------•-----•---•----------------- ---------•------- ---- - -- - j FINAL INSPECTION BY:- ae------------ .. - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stree+ 300 West Oak S+zea+ 132 Sycamore Street 814 No "C" Street Stockton. California Lodi, California � � Manteca, California Tracy)California . ES-9-2M Revised W-2100 JJJ