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APPLICATION FOR SANITATION PERMIT Permit No. --t. -------------- (Complete in Duplicate) `d// o p _ Date Issued ---.--r------- 5 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 Count Ordinance No. 549. Hildret Lane cross over RR tracks to -second street JOB ADDRESS AND LOCATION-------on-.the----lef t_s---house j ---the---end---af---t -Ls---r_-oad----.------------------------- Owner's Name--------- H.E.Sandau i f ----- ------ -------------------.... - ---------------- -------------------------------------- -- - Phone)�P3 71.5.5------------ Addre5513.5..x?rest-_.-n nth--g reet-------------F----------------------------------------------•--------------- --- ...-----------I----------I----- ----- Contractor's Name--- -A-t d- 5 3 &--Spz1S- Ir]C•--------------------------- ---------------- Phone HO— 96,Q7---------- Installation 6, .'7--------•- Installation will serve: Residence ® 1 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel El Other ❑ Number of living units: -I.-- Number of bedrooms _---2- Number of baths __1--- Lot size --------------------_-----------.---,... Water Supply: Public system ❑ Community system ❑ Private ® Depth.to Water Table 45- ft. Characterof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay.❑ "Adobe f] Hardpan ❑ Previous Application Made: Yes ❑ No 4 New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No ® r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or'cesspool permitted if public sewer is available within 200 feet.) k Septic Tank: Distance from nearest well---5W-P—ITIifance from foundation---1Q_- -_--..Material_----C_C- Br e --------------------- ~ Capacity 3,.200--_.---- ® No. of compartments---------�--------------Size---��r$]r!E']�[_________Liquid depth---- �-__- --_-_- - P Y--- c Disposal Field: Distance from nearest weN-50-.I--pl'Uoistance from foundation----10.__------Distance to nearest lotline--- .--------. © -----Len Length of each line---------_ 0f--------------Width"of.trench------2411--------_-------------- Number of lines----�,_______-______________ g �} Type of filter material__3---Rock-___.Depth of filter matena!-_-_--lg��-------.Total length- �Q--------------------------- Seepage Pit: Distance'to nearest well----1QQ!------Distance from foundation----3_Q'_______.Distance to nearest lot line------51------- rt [ Number of pits- ,------- Lining material----T'EkC k____---Size: Diameter--- --------------.Depth------ �. Cesspool: Distance-fro nm earest well---------_.----_Distance from foundation--------------------Lining material----------------------_----- ❑ . .- -------Liquid Ca acit r Size: Diameter--- --------------------- ------ ---Depth----------------------------- -------- q P Y gals. Privy: Distance from nearest well-----------.--------------------------------------Distance from nearest building-----------------------------__---.----.-. ❑ - Distance to nearest lot line----------------------------------------------------------------------------------=---•------ ----------------------------------:------------- Remodeling and/or repairing,(describef=-- ------------------- - ---------------- ---------------------------=----------------------- --------------------------- -----•---- ----------•--- - --- ------------------------------------- -------------------------------- --------- --- 1 ------------- r. - - -------- ---------------•---------------------•--------------------•-----------------•----------------------------------------- -------------------------------------------------------------------------------------- E 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. Si ned 7�♦ A�PI L a.rrish & riSnc --- __S_O_ ---I -----------------__-_._ ------------(Owner and/or Contractor) tI-Bill__right----------------------------------------------------(Title)---K-9:�-------------------------•------ (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 APPLICATIONACCEPTED BY-------- - ---------------------- --------------------------------------------------------------- DATE-----_0 _ � ----`mss-'---•--------------- REVIEWEDBY-------------------------------------------- -----------:--------------------------------------------- DATE.----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------ ---------------------- ------------------ _ Alterations and/or recommendations,:-- ----•------------- --------- --------- ------------------ - ------------------------------------------------------------ -- ------ --------- -------------------------------•---------------- - FINALINSPECTION 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 Manteoa, California Tracy, California ES-9-2M Revised 1.57 FY.CO.