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APPLICATION FOI,_ JANITATION PERMIT Pegnit No. (Complete in Duplicate) • Date Issued cation 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 complian'e with County Ordinance No. 549, I! JOB`AQQRESS AND LOCATION_.. 3P22__N. Wilson Way . --•-- ---------------------------•------- ---------------------------•--------••-- Wm;, Sweigart Phone ' Ho. 694o�4- Owner's Name = - ---- ----------�---------------------------------------------- --------- � ..- ..k, v .._ . Address --------------•-••:�e -------------------------------------------------------------------------------------------------------------------------------_-------------------------- -# Contractor's Name--•-=----------------•- - --Ds�ta -----------------------•----- ------------ Phone------3-12b9.... - Installation will serve:' Residence ❑ Apartment House ❑ .Commercial ❑ Trailer Court ❑ Motel QL Other ❑ Number of living units: ____ Number of bedrooms 8.---- Number of baths _i. Lot size ----2Q0 X 7 -_ -- Water Supply: Public•systen jfl Community system ❑ Private[] Depth to Water Table 35__ ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [3 Hardpan ❑ , Previous Application Made: Yes ❑ No]E] New Construction: Yes [JX No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance:from nearest well_________________Distance from foundation-------------.------Material ________..___..__.___.._______._._._____-__--. i Elilisfn -.___..___Capacit --------------- y No. of c4ompartments Size Liquid depth Dis osal Field: Distance from nearest well________________Distance from foundation--------------------- to nearest lot line_______..._______ Epi sting Number of lines------------- - -------------------Length of each line----------------------------.Width of trench-.--------------------------------- j Type of filter material----------_--------------Depth of Tilt erial________.___.__...___Total length_________.____________.._____:___________ 1 Seepage Pit: Distance'to nearest well-.__n9------------Distan rom foundati n-_�cp_________-.Distance to nearest 5 _ I Number of pits---.._______-------Lining materia ,___br _.Siz . Diameter__�1__..---_--.-___Depth__-. ��_ Cesspool: Distance from nearest well-----------------Distan from anon Lining material---___.. ❑ Size: Diameter---;---------------------------------Depth-----------------------•------------ ---------Liquid Capacity------------•---------- 9a15• 1 Privy: Distance from nearest well________________________________________________Distance from nearest building----------._______________----.___._-_._. ❑ -Distance to nearest lot line..._.-._- _ --------------------- = -- _-----------------•------------------------------------------ Remodreling and/or repairing (descrybe):----------addingsecpa e••-plt--_to---_existing_..g!ptj Cq System ------------------------ i } ------------------------_----------------•-----------•----------------••-•-----------------------------------....-------------------------•---------•----.-------.._- -----._-.---------JoaquV ! hereby certify that I have prepared this application and that the work will be done in accordance with San in County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-.-----------------------••-----------DNlt$---------------------------------------------------------------------------------------- ---------------------(Owner and/or Contractor) By:............................•--------•-•J...Perry Warthan (Title} ��r= ---------------------- (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 ------ - REViEWEQBY ................. ------ ------------:------------------------------------- -------- DATE--------------- BUILDING PERMIT ISSUED - ---- DATE ---` ------------------------------------ -------------- -- Alterations and/or recommendations:---------------------- --- ------ .-----------------•-••----------------- •--•--------••-•-------K,-�--�..•• kl . . -------------------------------------------------- i♦ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________ FINAL INSPECTION BY;-.-gA-j Date.----- -- CS r { --------------------••-------•---------... 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 E3-9-2M 145446 ATWOOO 12.54