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Y I APPLICATION FOR SANITATION PERMIT i� (Complete in Duplicate) ` 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-----17--- r-----------'------------------------------------------- --------------------------------------------------------- Owner's Name--- ThUrman-__L-- JohZ18gn-------------------------------------------------- Phone----2_;4-x--9-- Address----------17 Contractor's Name-----DP-lt a__-Sept_la---T_ank--Seraloe---------------------------------------------------------------- Phone--3-3955--------------- Installation will serve: Residence © Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Ij Number of living units: EL Number of bedrooms [2 Number of baths �]1 Lot size------3_Q---X---105_________________._-__ i Water Supply: Public systelm [;: Community system ❑ . Private ❑ Character of soil to a depth of 3 feet: Sand'L] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe P( Hardpan 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------------------Distance from foundation_.._.....__________.Material-------_--------------------------------------- E]axtst Ing No. of com artmen+s------------------------ Capacity-----------------------Size------------------------------.-Liquid depth---------------------- Cesspool: Distance from nearest well----------------_Distance from foundation--------------------Lining material_----______________________________ � ❑ Size: Diameter_.------------------------------------Dept h------------------------------------ --------------- Privy: Distancel from nearest well-________________ _______________________________Distance from nearest building_--_---__---------------_------ ❑ Distance to nearest lot line____________________________________------------ Seepage __________ ,I P 9 � _ D'S�ance to nearest lot line----0;-___ See a e Pit: Distance to nearest well______________________Distance from foundation__ ___ ___ ____. [R] Number,of pits_____1______________Lining material----CeDl£�I'�'�i___Size: Diameter-.-_ ________________-.Depth-._ _-/_ --____ P . Disposal,Field: Distance from nearest well-----------------Distance from foundation___________________Distance to nearest lot line----------------- f ® Number'!of lines------....3-----------------------Length of each line_4PP--•----50--------Width of trench_W1-------------------------- Type of,'fiiter material_____x'_O_0_k--------Depth of filter material___�w___________ Remodeling and/or repairin` �g (describe 1�---- - - Pairing---m---lar_ .--aegt_is---Banti,---P-UMPed--- ---------------- --- ------------------------------------ --•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ` 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. II (Signed)..........Delta__ g _�C..-T'ax2Y�. ------- --- -- -------- -- ------ -- -------------------------------- By: - (Owner and/or Contractor) - --------------- By:..--------F.err_y..Wart_ TA --- ----LTi+lej_Owner�M r----------------------------------- (Piot plans, showing size of lot, location of sys em in el o to wells, b ildings, etc., mus+ be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED"BY __ __ DATE------- ----------------- REVIEWED ------------- -- REVIEWED BY--------------- ;' ------. f`-6-------------------------------- ------------------- DATE------------------------ ----------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------- j; Alterations and/or recommenda+ions----------------------------------------------------------------------------------------•-----------------------------------------------------------•- I ,I ----------------------------------------------=----------------------------------------------------------------------------------------•--------------------------•------------------------------------------------------- , I --------------------------�f-t-- --- = - II yy PERMIT No.pZ_//----_------_.-ISSUED-----e✓_- ----. 1_-_ J_-----(Date). FINAL INSPECTION BY------ ------ ---- ---------------------------------------- II Date ------------------ d SAN JOAQUIN LOCAL HEALTH DISTRICT ll 130 South American Street q Stockton, California ES-4-2M 9-50 W=1639 II , _1