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` b APPLICATION FOR SANITATION PERMIT Permit No. ...� - +� (Complete in Duplicate) V, I 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. JOBADDRESS AND LOCATION-.---------�43---dat_erlcaa---Rd,-r---------------------------------------------------------------------------------------------------- Owner's Name-----Hari Y------------F_Qt-ta '--------------------------------------------------------_-.-------------------------------------------- Phone---3_--547-0---------------- Address--------s3Me---------------------------------•--------------------------------------------------------- --------------------------------------------------- ---------------------------------------------- Contrac.tor's Name------------De-Ita------------------------------------------------------------------------------------------------------------------- Phone---3v'-3-95�---------------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1_ Number of bedrooms _2_____ Number of baths .-I____ Lot size ---------5(LX-j_QQ____________________________________ Water Supply: Public system ® Community system 0 Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IN Hardpan 11*11%% Previous Application Made: Yes ❑ No j] New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: F . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-- _________--__-_.Material-_______________________________________________ Exis®i:ng No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line_--_____________- ExisEing Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material----------------------Total length------------------------------------------ _ Distance to nearest lot line_--__ -____-_--- Seepage Pit: Distance to nearest well-___-______________Distance from foundation_____.> _______._.--.Distance � ® Number of pits----- material___b ' k_____ ------Diameter-____- __6_____ Depth_.___ - ----------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____________---_.-_-__________•-___. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--_-----------------------gals Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____--__--__-_________•-•-.______-_-----. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------•--------------- --------------------------- Remodeling and/or repairing (describe):-------------------------In talbrig__new---ve, t_lzal---dra.fl7- and----10_o3 ing__UP- ta---exiiztnrzg,__ ra1n---w1gh---80d-id---11-M-----•-•-----------------------------------------------------------•-----------------------------•----------------------------- --- ---------------------------------------------------------------------------------------------------------------------- ------------------------------------...------------------------------- 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)---------------- ?el a----------------------------------------------- (Owner and/or Contractor) BY: --------------------Perry ,far#.hen ----------------(Title)---4wn�r.-1gr_,------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). y FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY -------------------------------------------------------------------------- DATE---�'i�j ------------------------------------------------ REVIEWED BY-_------------------------ T -------------------------------------------------------------------------- DATE--------1�`--------------- -. --------------------- BUILDINGPERMIT ISSUED------- ---------- ---------------------------------------------------------------------- DATE------------------&---------------------------------------- Alterationsand/or recommendations----------------------------------------------- ------------------------------------ ---------------------------------------- ---•--------------------- k ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ---------------------------------------- / erf / FINAL INSPECTION BY-----------CN._I/_-#------------ ------------------------------------------- ----------------------D--a--t--e----------------------/-V j------------------------.---------------- f SAN JOAQUIN LOCAL HEALTH DISTRICT 1310 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