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FOR OFFICE USE: -------------------=--------------- - ------------------ APPLICATION FOR`SANITATION PERMIT Permit No. ....,,/f_ �L3_ ---------------- --------------------------------------- (Complete in Duplicate) Date Issued .__-.`.X)1.- / ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued �(---�-� Application is hereby made to the SanJoaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Counfy Ordinance No. 549. JOB ADDRESS AND LOCATION-------------- ---45 8---Y -rgu--•• --------------------y---------------------------------------------------------------------•-------------- Owner's Name •--TsaiCas--Ca�2Ca An el- rLCx ---C.45.t-ellanos. ---- ------ Phone....no-------------------------- Address.......................45,2&&... i.t-gil --' nf_._Che_r.aAee__�Lane---------------------------------------------------------------------- �A Contractor's Name------ -•----------------------------------------- Phone_-__$.q_-_%3-1.,?6.9----- Installation will serve: Residences Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ Number of living units: --1---- Number of bedrooms __-_2 Number of baths A--- Lot'size ----- ------------------------------- Water Supply: Public:system ❑ Community system ❑ P'rivateE] Depth to Water Table _4.5_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,& Hardpan [] Previous Application Made: (If yes,date-:---_--""--"----"--) No ❑ New Construction: Yes [ No ❑ FHA/VA: Yes ❑ No Ej ; 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 foundation--------------------Material----.-------_----------__----_-_----..--_--__--. No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity....------------------- Ext ing Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-___----.--.----- NxzMt ing Number of lines---------------------- ------------Length of each line------------------------------Width of trench------------------------------------ Type of filter material-------------------------Depth of filter material-----------------------Total length-------------___--_-----_---_-----:-____:_ Seepatju-Pif Distance to nearest:welL___.___AW__*Distance from foundation---..-. Distance to neares line...... ® SGiAPf Number of pifs--------.Z---------._Lining material----Ta-ak-------Size: Diameter----- Depth �_--max„---- Cesspool: Distance from nearest well__:_------_----^Distance from foundation----- "-----------.Lining material---------------.------------ Size: "--_-_"_-_Size: Diameter------- ------------------------------Depth.-------------------------------------------------_Liquid Capacity---------------------------- Privy: _ Distance from nearest well ---------------------__----_---.--.-_-�___r__Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line-----------------------------------------------------------------"-••- ----------"••----"•-----•--""----"------------------- ------ Remodeling and/or repairing {describe)--------------add- -ng----Fi;1 terF Bed----to-•-ex -&&ing...6-yetem---------••------------------------ -------------------------------------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 +he San Joaquin Local Health District. (Signed) -De,i_taA__Se t_i_c.--Tank__Se-rUzceZ-nc--------------------------•--•--------•---•---------------(Owner and/or Contractor) By:--------Peg=y--Q.!---- arth4n--------•---------------------------------------=--------------------------(Title)--Gen.---Mg-r------------- --- ------------ (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---------Ak Z�`-�J--------------------- REVIEWED BY -------------- -------------- DATE 7-%---= '. BUILDINGPERMIT ISSUED__.----------------- -------------------- -----------------_- •--------------------------------- DATE.----------------------------------------------------------- J/kItleF/r/$+ions and/or recommendations:------------=---=--------------------------------=------•--....--..::.-•-•-------------------•----•--------•--...........:---•-------------------------------- / ---'-------- --- - ---•-------...------"-""... """ """"" '""---.------____-----------•--. ----'---------- •---------•------------------------_- I f FINAL INSPECTION BY ----------------- -- _"" Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVie@C 0-59 P.PXP.aM 6.60