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APPLICATION FOR _ANITATION PERMIT Permit No. ._�Jtr�. (Complete in Duplicate) Date Issued Applica+ion 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------------------------------------------------- --------27Y9 - -------------------------------------------------------------- Owner's Name-----'.&ck._J.&cX.XQrrU1------------------------------------------------------------------ --------------------------------- PhoneHo.....3`"0802 Address---------------2749---Sit- "B"...St• ......s�k� n' � ---------------•-------•---••-----------•---••------•-------------------------------------------------------------------- Contractor's Name-----------------API t-. H0� 3..1269 - ----------------------- ------------------------------------------------------------------------------------------- Phone------ Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other.❑ Number of living units: _1-_-_ Number of bedrooms _2__._ Number of baths ._1--_ Lot size _100 x 125 Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ .Adobe] Hardpan Previous Application Made: Yes ❑ No K] New Construction: Yes A 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_________________Distance from foundation--------------------Material ____.______..__.______,_._____._____.___________. ex!151ting No. of compartments----------- --------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field- Distance from nearest well-----------------Distance from foundation-_-----------------Distance to nearest lot line................. exUting(n.. Number of lines-----------------------------------Length of each line------------------------------Width of trench.------------------- Type of filter material___----------------------Depth of filter material-------------.---------Total length_-_._--_---__--___---_--_-____----___-__-_ Seepage Pit: Distance to nearest well no -_-_--Distance from foundation_._10_..._....Distance to nearest lot line 5 ® Number of pits._ --------- --Lining material--briCY------Size: Diameter___---_3-------------Depth____d! .:__.. ;' . s.;' Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______----_.----___--_---_---_.______. ❑ Size: Diameter------------ ----------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well___----------------------------------------_-----Distance from nearest building-------------------.____--___-_-_--_--_.-. ❑ Distance to nearest lot line---------- ---•----------•------------------•-------------•----•---------------- Remodeling and/or repairing (describe):-----adding---8_C-Cp- ge-__pit---t-Q eXiE.ting....septj z---ayat-em------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will bg done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----•---- DClti� --_--__-__-___-=__-(Owner and/or Contractor) By:-----------------------Perry Warthan ------ (�_GnM ---------------------------------- Title_-. (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_ y------------------------------------------------------ REVIEWED BY ---- --- ------ DATE- �-- BUILDING PERMIT ISSUED--.-.-- ----- ------------------------------------------- ------------------- DATE------- -- Alterations and/or recommendations---------------- ----------------- -------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- -------------------------------- -------------------------------------------------------------------- -----• ---------------•--- ------------------------ --------•------------------------------------------------------------------------------------------ ----------- --------------------------------------------------------------------- FINAL INSPECTION 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 145446 ATWOOD 12-54