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I APPLICATION FOR SANITATION PERMIT Permit No. 1 (Complete in Duplicate) 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-__--_-' 1.551 North Chronicle Owner's Name .Tack F].22nOr-------------•-----------------------•------------------- Phone H0 -9459 --------------------------------- -- Address--------------------Same as above _ ------------------------------------------------- ---------------------•---------- Contractor's Name---------PaxTj-sh-4 ---S.Dt7� _.- --------------- -------- ---------------I----------------------------------- Phone......H06--902 Installation will serve: Residence K] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units; A--- Number of bedrooms --2---- Number of baths __1_-- Lot size------ r 5�5�•------- Water Supply: Public system'®"Community system ❑ Private ❑ 'Depth to Water Table ----I+-5k Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeE Hardpan [] Previous Application Made: Yes ❑ No FK] New Construction: Yes ❑ No [jj FHA/VA: Yes ❑ No [j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tenk`or'cesspool permitted if public sewer is available within 200 feet. Septic Tank: Distance from nearest well__--------------Distance from foundation--------------------Material -.__._________-_ ftiSting No. of compartments------ ------Size--------------------------------Liquid depth--- - --------------------- --------------------Capacity----------------------• Disposal f=ield: Distance from nearest well--- from foundation-_-_ --------Distance to nearest lot ]-Lie__10_i_-_-___ 1] Number of lines-------�--------------------------Length of each line.--------5��_____._____--.Width of trench-----------2: 1 ------------- Type of filter materiaf-----S---Tac*-_Depth of filter material----18ft----------- otal length------- --------------------------- Seepage Pit: Distance'to nearest well.....none _ _Distance from foundation___ ��---------D s ipce to nearest jp l;ne---$�.________ ® Number of pits-----1--------------Lining material-_.---.rack£ size: Diameter-----_----------------Depth----- --------. ----- r Cesspool: "distance from nearest well-----------------Distance from foundation--------------------Lining material----_-__----.-.----..------_--__ . .- ❑ Size.-Diameter-------------------------------------Depth-------------------------------=-------------------Liquid Capacity-- .------------------------gals. ' `t ❑ Distance to nearest lot line-_------Lr __._ Priv Distance from nearest well_________________--------------------------------Distance from nearest building___________________________________ Y' ----------------- Remodeling and/or repairing (describe)----------------------------- _ - - ----------------------------------------------------------------------------------------•----------------------------- I herei'y 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. (5i d '9ne ) Parr8� 95_' (Owner and/or Contractor) BY: - -----•.-Bill-- WTight - --------------------(Title)------ Est-----•--•-•----------------- ---------------- (Plot plan, showing-size of lot, location of system in relation to wells, buildings, etc., can 6e' placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION'ACCEPTED BY-----�-R-.Q---------------------------------------------------------- --------------. DATE----- ....................... REVIEWED BY-------------"---------- -------------------- --------------------------------------•-------------------- DATE ----------- BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------------------._ DATE------------------ ------------- ----------------•-----•- Alterations and/or.recommendations: -----------•---•------- -------------------- -••-•- ------ 3 ---------------- 1------Z-5- ---------------------------- FINAL INSPECTION' BY:--=a4m1k'---------------------------------- 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 Manteca, California Tracy, California ES-9-2KI Revised 1.57 F.P.CO.