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v APPLICATION FGSANITATION PERMIT Permit No. _��..7.. ..7.... (Complete in Duplicate) Issued J d E z- id / `�J y _ _ Date ! Application�is ereby ma a to the S n'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 77.1--.+gam..:©�-Dell------------ ----------------------- ---------- •=-.... Owner's Name-----_John and Lula (lou) .Comet. PhaneHo------------------------------ Address __.-- 1.S4h -------------------------------------------------------------------------------------------- ---- - -- 3--------------------- -ter�- -..... .. w� •�, - �,. .. � .� Address------------- Bf::II1A r -------• -•-- ---------------------------------------- ----------------------------------------------------------- ------------------------------------------------------------ Contractor's Name_1 1,DeltB_-SepticT&11k'_a�ld---C 88pbol---_��_�Y`Vr�---------------------------------- - PhoneHfl----�`-�a�- --------- : �7 Installation will serve: Residence W` Apartment, House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number oflivi. * kl 2 1 size _...-.1-acre --------------------------------------- Water Supply: Public system ❑� ' Communitysyst system Private ®r Depth to WaterTable 'ft. Water Character of soil'to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy.Loam ❑ Clay Loam ❑ Clay [] Adobe [3 Hardpan ❑ Previous Application Made: Yes ❑ }No,[Z New_Construct,ion4 Yes,©-No-E] -.-FHA�I,A:Yes.O---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 eell ._-.- Distance from.foundation----------- - -----Material--------------------------------- --------------- E2i]BtIng No. of compartments ---- ----- = Size -------------=-- -------Liquid depth Capacity Q�sppsal field: Distance from nearest well.... ...........Distance from foundation-.r. ._._-_-.-__.Distance to n'aresf lot line__-.--_.--.-....- E9tng Number of.lines--f--------------` }[ Length of each line------------r--- -----------.Width of trench----------------------------------- Type of filter material.:.'___._,- ------------Depth-of-filter material------ .-----------------Total length.],_-.-..__...._..._..--...._----------- Seepage Pit: Distance to nearest well__"�.V©----___._Distance from..foundation_..IVO- _.Distance to nearest lot line.- P;- ® Number of pits---'- -----material------ '� k_----Size: Diameter----- Hp----.-----.Depth------�5 ------------------- \! Cesspool: D stance*from nearest well 7 Distance from foundation-------------- f .... ---- Lining material.................................... �t ❑ Size: Diameter--- --- - Depth'". ' "`�"'- �-o �-.r-Liquid-C-apacify --------------------gals, i Privy- Distance from nearest well__ ------ -------------------------------Distance from nearest building------------------------------------------ Ej "--Distance-to'nearest lot line-=---"----Y------- ,. ._...,._._-. _ r_ ---------=-------------- Rem eiing and {descril.a}:------_--_ad_-IIZ ..-g'ep .-. B.- ` -to __ __I tIng_. ByBteM r P - - -- ------ - - --------- ---------- / �-r�c�.Jay �- ---------- - ---- --. - -----°-------------- ----=- -------.-------------------;---------------------------•----- ------------------------------------------------------------- I hereby cerfify.fhat 1-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 S,an Joaquin-Local Health»District. �e�, A�---xie r �:` ---'-------'z-------------------- --- -Owner and/or Contractor (Signed - [, / ) By:-----------= Perry_ War_thane x t------------------{Ti+le)_.( en. A r• r ---------- ,, > ----------------------------------------- (Plot plan, showing size of lot, 'location of system in relations to wells, buildings,' etc., can be placed on reverse side). ' .. FOR DEPARTMENT USE ONLY REVIEWED BY ------C -- - - ------ � �----------------------- DATE APPLICATION ACCEPTED BY---------------.-.--- -- -------------- DATE 'f = ;- --------------- --------------------------------------------- ------- --------------------------•---;------•-- - / BUILDING PERMIT ISSUED..--,-- -- .. - s� = D E fM - `= -;..-- V" Alterations and/or.recommendations:..__.. _._-...- // - � ------------------------------- -_------------------- ..---- ?- --.. -. 44e �.. ------------------------------------------ f------------- --------------------------------------------................... .- f` ----------.-------------------.-------------------------------- . .__.....___.-_----_,-._........_.-.._.._.._-....-._---......_-_-...._..-._..__--_.-..-.-.......__.._.-----------._..--.._..__.._..-- ------.._..------------- FINAL INSPECTION BY:. _ -- ---:._ ---- .:_ Date=- SAN J AQUIN 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 _ y ES-9--•2M , Revised 1.57 F.P-CO. .>: 4