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APPLICATION FOR SANITATION PERMIT Permit No.A_c�____L___/__ (Complete in Duplicate) Date Issued . I' A Application is hereby made to the San Joaquin Local Health District for a permit to construct and install +he work herein described. This application is made in compliance with County Ordinance No. 549. ' JOB ADDRESS AND LOCATION-----------215Q__ ' 5th__651 s• Owner's Name A ? I"• Jo-nes------------ --------------- --------------- Phone--- 2- .L 45-------- 1 ------------------------------------------------ - Address----------------------------2.15-Q F,-l--._5t.h__S.L_._� � Contractor's Name-----------AB_lt& i --------------------------------- Phase3355--------------- � Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 2__.__ Number of bedrooms ___2__ Number of baths _2____ Lot size __.171X2_3_0 Wa#,,pr,5upply: Wa#er, 5upply: Public system ❑ Community system fl Private ® Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No a New Construction: Yes KI 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 welL____5Q------Distance from�foundption__&!-------------Material___-Cemant_-_br_i_ck----------- " 91 No. of compartments---------2---------------Size----- �----Liquid depth--- ----&---3-i-_-_-Capacity_-8QQ------------- Disposal Field: Distance from nearest well___5-0.1-------Distance from foundation------10'-------Distance to nearest lot line____ -------- fil Number of lines------1--------------------------Length of each line----50-------------------Width of trench-------2-;--------------_------- Type of filter material-------r'S7G_k------Depth of filter material___1551"------------Total length---SQ-1______________________________± Seepage Pit: Distance to nearest weli____85............Distance from foundation------1_Q_!-------Distance to nearest lot line__...r31-------- El Number of pifs___._1---------------Lining material---br_i_c -----Size: Diarneter__3Q-u--------------,Depth----- -j---------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------- ------_Lining mate rial______________________________--_-._.� ❑ Size. Diameter------"------------------------------Depth---------------------------------------------------Liquid Capacity gals. Privy: Distance from nearest.well------------- -----------------------------:-_--Distance from—nearest-build ing--__=,-=_r,__-•_;- a _4 ❑ Distance to nearest lot line------------- Remodeling and/or repairing (describe)----------------Inat_alling_..never----system_.------------------------------------------------------------------------. -----------------------------------------------------------------------------------•-------------------------•-----------•-------------------------•-----•--------•--------------•---•------------------------------------ 1 -------------"--------------------------------------•-------------------•---------------------•-----------------------r---•-------------------------------------------------•----------------•------- --------------------- 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. (Signed)........Delta--------- ------------------------- �--------------=------------------------------- -------------------------(Owner and/or Contractor) By:--------- ��X' -!� 'k•b1s J, = -- = ---------------------------------------------{Title)-------owme-r__ k1gr_----------------------------- (Plot plan, showing size of lot, location of sy, em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•-- -- -- -- ------ __ DATE----------- -- ------- REVIEWED BY ------------------------------------ DATE---------- --------- .A f ---------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------- ------------------------- AlterationsF and/or recommendations:-------------- ---------------------------------------------------------------------------------------------------------------•--- ------- --- ---------- ------- i ----------------------------------------------------"----•"------------------------------------------------------------------------------------------------------------------------------------- --------------------- --------------------------- -------------------------------------------------------------------------------------------"--------------•-----------•--------•--•-------------------------------- ---------------------------------------------------------------------- ----------------------------------------- -------------- ---------------------•--------------------------------------------------•--- FINAL INSPECTION BY:----- ----.----------------------------- Date.-------- = 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-2f00 ! t