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m v �14V, APPLICATION F("'�SANITATION PERMIT Permit No. .... z3_____-- (Comple+e in Duplicate) 3 Date Issued e�Applica-lion 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--------1-9-76-__-4 .... rake--I ---------------------------- Owner's Name-------LOLL._;3_..k1 C---=-------------------------------------------------------------- -----------------------=-------------------- Phone-_H�-"-•--6-7&)48 Ad d ress--••---------------192-6...5-.....D '�k�----------------------- ---�----^�,..„ Contractor's Name-----------Pi ta---------i----------------------------------------------------------------------------------- -=-----------•------ Phone---------?-wl-769--------- f Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _J------- Number of bedrooms _Z____ Number of baths _i____ Lot size Water Supply: Public system F] "'Community system ❑ Private ❑ Depth to Water Table -Sf]__-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe [2F Hardpan ❑ Previous Application Made: Yes ❑ No [I 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__rQ---------Distance from foundation---1-q-----------Material _________________________________.__________- ext sping No. of compartments--------------------------Size--------------------------------Liquid depth-------.---------- --------:Capacity------------------- Disposal Field: Distance from nearest well------------------Distance from foundation-------.------------Distance to nearest lot line_________________ exisnLng Number of lines-----------------------------------Length of each line-------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length___________________________-_______-_____ Seepage Pit: Distance to nearestwell_.___ _nP-._______Distanc�erfrrrom foundation Q;___2____.Di'tance to nearest lot line_____51__y__ ® lumber of'pits_____--i ------------Lining materialbrce---------------ick-------- Diameter----- ---------------Depth------ Cesspool: Distance from nearest well--------------___Distance from foundation-----------;--�_t.,Lining material--------------------------------F" [] Diameter-: ----= ---=- :Depth -------------------------- Liquid Capacity gals. ,. r. ... _# , ' , .. .,_, ., �t _ Privy: Distance from `nearest well___________________________________._______.____Distance from nearest building__________.____--_ ❑ Distance to nearest lot line ' ______________________ -----------------=----------------------------=------------------------------------------ ep Remodeling and/or repairing (describe):-_--------i3C�al - g�------� )7 t-------------••----•-- -------------------------------------------------------------------------------------------------------------------------------------------------------- •------------ ----------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------- _______-____ i I hereby certify that I-have prepared this application and,+hat 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) D Z-— ---------------- k -'------------------Owner and/or Contractor) By:---------------------I---Perry!'Warthan (Ti+lel M��'^ ---•--------------------------- (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--------�-•------------------------------------------- REVIEWED BY------------------------------------ -- - ------ --�� ---- ---•-----------•---•---•------ ----•-------• DATE------------------,-'�--------------------------.__--------- BUILDING PERMIT ISSUED------------=----------------- ------------------•--------....--------•-- DATE------ Alterations and/or.recommenda+ions:.-____________ --------------------- ------------------------------------------------- -•-----•-------•--- ------------ - --------------------- ------ --~ -- ".----=...... --�------------- --------b------------ !'-------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- ----- ----------------------------------------------------- ----------- ---------------------------------------------------------------- ------------------- ---------- ------------------ FINAL fNSPECTION 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 Manteca, California Tracy, California ES-9-2M Revised W-2100