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APPLICATION FOR SANITATION PERMIT Permit Nb? �� ------- (Complete in Duplicate) Date Issued _-/ _-___------ Application _---_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-------- -------------------- -- ------------------------------- Owner's Name-------------------• ----P-erry-_3�mter---------------------------------------------- ----------------------------------------- Phone---2-------------------------------- Address----------------------9QQ__-P1 ------------------- ------Address----------------------9QQ__-B].o Ck__A._---QIAYe---At------------------------------------------------------------------------------------------------------------------------------ Contractor's Name------ Delt ------------ '------------- ----------------------------------- Phone-- "' 3g , Installation will serve: Residence E)[ Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ e Number of living units: ___I__ Number of bedrooms ---1--- Number of baths -1----- Lot size _-_-________50,-x__]_0Q_______-__-_----___-__,_ Water Supply: Public system :K] Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R Hardpan ❑� Previous Application Made: Yes [R No ❑ New Construction: Yes ❑ 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.-----m---------Distance from foundation-----a'-----------Material------ ------ .11 No. of compartments-----------------2-------Size----61_X41-X4_.......Liquid depth---!- 3-1----------Capacity--•-aD-a_____------ Disposal Field: Distance from nearest well---------------Distance from foundation-----IQ--------Distance to nearest lot line-----------.- .• El Number of lines-----------------J-___-___________Length of each line___75------------------_Width of trench-------21---------------------- _ Type of filter material______r'QC1C-------Depth of filter material ______-__19......Total length_____7.5_1______________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number..of pits----------------------Lining material--------------------._-Size: Diameter-----------------------Depth--------------------------------- Cesspool. Distance from nearest well_________________Distance from foundation_____._-------------Lining material---------------------------___________- - Size-:--Diameter_,—,== _=-•------ -- Depth :;.: Liquid Capacity gals.+t Privy: Distance from nearest well __________________________._------------------=—Distance from nearest buitding______= _______T___=__________---- ❑ "Distance to nearest lot line----------------------------------------------=--------------------------------------•-------------------------------•---------------- : r fF Remodeling and/or repairing {de'c`ribe):---------------------------------------------------Raw__-1n8ta17,.-Z3_t_1on---------------------:---------------•---------- :. --------------------------•-----------------------------------------------------------.........---------------------•-----------------------------------•--•----------------------------------------------------------------- -----------------------------------------------------------------•----------------------_--------------------------------_----=--------------------------------------•-------------------------------------------------------- I hereby certify that 1 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 � (Signed) ---- #........Ilel_tp--¢----------------------------- ----------------------------:----------------------------------------------------(Owner and/or Contractor) By----------------------------Peri'-yjkamihan---------------------------------------------------------------------(Title)_011nB.?'-=-4_'------------------------------------- (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__-�j1----------------------------------------------- REVIEWED BY----------------------------- �„��-----------------------` DATE ---------------- BUILDING PERMIT ISSUED DATE S"------------------------------ Aiterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------_--------- -------------------•----------------------------------------------------------------------------------------------------------------------------------------------------••-----------------------------•---•------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------- ----------------------------------------------------------- ------------------------------------------------------------------------------------------------••--•-------- FINALINSPECTION BY:---------I -------------------------------------------------- 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-2100