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PLICATION FOR SANITATION PERMIT Permit No. .�_ _ b (Complete in plicafe) U Date Issued 7-/Z#//-.- WApplication is herZyv/made toASa, quin Local ealth Dis rict 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________________R:t_.---3,___Bex---5_3_8-A.-fl-ff---Aahley---Lane---S...... sL__IeJ_and,__W_y----- Owner's Name_A_.- L..._BQeil_r- ---------_ 5th house on .eft after turning S . I�ne�'e __ -- Address t/Tf- -�W `�'-----ww j- — ` �''` 't �� {1/ ----•------- Contractor's Name-------Ue_It3L------------------------------------------------------------------------------ _- _----- = Phone '> Installation will serve: Residence El Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ .__ Number of bedrooms .__2__ Number of baths -1____ Lot size __la r_c_______________._-___________________---__ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table ________ ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan li;k 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______ _t-Distance from foundation----/___/-__Materialc,,. -►--to' R_r____-_" No. of compartments------- _.__- Size-- �._ !�_X'�'Liquid de th___0"__ _---3--,---Ca acit Disposal Field: Distance from nearest well__ Distance from foundation______8.......... Distance to nearest lot line___ __________ Number of lines________-I------------------------Length of each line_ _�Q____-Width of trench-------2_________________________ Type of filter materiaL___rt7.c$_._____Depth of filter material-----------1-8'-1.---Total length_- 60l 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. Privy: Distance from nearest weft_______-----------------------------------------Distance from nearest building_____________-__-______________-_______ ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodelin and/or repairing describe :______ har ani. h__and.___a aw a,y-`. -ram - ;� ink ll- -'r : - - ------------------------------- ---------------------------------------------------------------------- ------------------------- --------- -----e---------------------------------------------------------------------------------------------------------- I hereby certify that I have prepay d 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)-----------------------------------Delt-a------------------------------- (Owner and/or Contractor) Parr Wart tan- `- (Title) Q_zaner_-T;g�' �' (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 ,l APPLICATION ACCEPTED BY--C ----------------------------------------------- -----------•--------------------------- DATE ------------------------------------ REVIEWEDBY--------------------------------`-7F!--------------------------------------------------------------------------------------- DATE---F' - BUILDING PERMIT ISSUED--------------- -------------------------------------------------------------------------- DATE--------------O --------------------------------------- Alterations and/or recommendations--- --------------- --------------- ------------------------------------------------ ------------------- ----------------- -------------------------------------------------------- ---------------------------------------------------- --•----------------•--------------------- ------------------------------------ , a� �-•-- ----------------------------------- -- �------------------------------------�------------�L �------ ------------- �- ---------------------------------------------------------------------------------------------------------------- ----------------------------- ------ I FINALINSPECTION BY----------------------------------------------------------------- Date------------------------------------------------ ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT-- 130 South American Street 300 West Oak Street 132 Sycamore Street 814'-t4orth "C" Streef i Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100