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2�y� -S-✓ APPLICATION FOR SANITATION PERMIT Permit No. ` (Complete in Duplicate) 1 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-----------594--S- Vent-a-ra----------------------- ------------------- ------------------------------------------------------ Owner's Name-------------------' 1111e---MCK.li-inn-y---------------------------------------------I------------------------------------------ Phone---4-7.002---------------- Address----------•---------------------6 Q4--2-a---V e=tur_a----------------------------------------------------------------I-------`--------------------------------------•----•-------------------- Contractor's Name-------------------------De_Ita.----------------------------------------------------------------------------------------------------- Phone---3--39-55--------------- Installation will serve: Residence ® Apartment House ❑ Commercial [-] Trailer Court ❑ Motel El Other E] Number of living units: --- I- Number of bedrooms -_-2_ Number of baths --1___ Lot size -------5OX10O____________________________________ Water Supply: Public system ® Community system '❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 12 Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ 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-----------------Distance from®T foundation_____--_-$!_____.Material-___Cent—br ck-------- No. of compartments------------2-----------Size-----�1-x4tX4l-----Liquid depth--_5__$aa_'_______._Capacity-- QO------ _-- i Disposal Field: Distance from nearest well-________________Distance from foundation--------------------Distance to nearest lot line____-_-___-____-• ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length_-___--_________-_-__________________--_-_ f Seepage Pit: Distance to nearest well--------------_-------Distance from foundation___�1------------Distance to nearest lot line-----41____-__ i ® Number of pits------1--------------Lining material----b _ Ak-----Size:.Diameter----- 1--------------Depth------25-------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------.-_-___. ❑ Size: Diameter-------a-----------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___-_-_---.__________-___________-.------ i ❑ Distance to nearest lot line--------------- �---------------------------------------------------------------------------------- ` ri tWa_ __ cem nt. br_I_�k_._se_ t�i_c___ nks----and-------•-• + Remodeling and/or repairing (descr.ibe�:.-__PIIS a111T1�_ �_ _ -_ P --bo-Qking- --to...�he..new =pert-3,c�7 With P-Qli.d---11 e-..aPPrax mately---l0�ft- ------------- '---------------------------------` -= ------ 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 HealtK/D;stricf. ' -------- ;s trac+or)(Signed)_ ----------- � �------\--------------------------------{Owner and/or Con Owner--Mgr .WarthanPeer f (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 I - -—�- ----- DATE------------------------------------------------------------ APPLICATION ACCEPTED BY---------------- - �- -----�---- - -----------�•-------------------------------------------- REVIEWED BY--------------------------------------- DATE- ---r BUILDING PERMIT ISSUED----------- ------------ -------- DATE------- `-�� `----------- -------------------- ----------------------------------------------- ---------------------------------- ` Alterations and/or..recommendations:-------------------- /-------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------- ------------------- ---------------------- ------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- .. ---- - ---- --------------------------------------------------------------------------------- -------------------- # ` ..... Date_- _'=. ._f _.�`"� 'mow.,=---------------- -------------------- E FINAL INSPECTION BY., --;_.____--_ SAN JOAQUIN LOCAL HEALTH DISTRICT Y 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street r Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100