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APPLICATION FOR-`SANITATION PERMIT Permit No. ..L `�---- (Complete in Duplicate) z 1 G J This Permit Expires-1 Year From Date Issued Date Issued 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. r . - -------------- ---------------------' -------------------------------------------------------------------------- JOB ADDRESS AND LOCATION31uOltt Owner's Name--------------t_eS!3Ah9._&-_Corrin Mack ------ Phone.Hgm----34888----- --------------------------------- Address-------------------•---_--351a-.. l---Q-t-Q-011 --------------------------------------------------•-------------------------------------------------------- ..---------------------------. Contractor's Name-----De11a.J5ep jp-__Tank-- SE'`x'V CF'. -._-IFIC.------------------------- -------------------- Phone_HO....t3— 269- Installation will serve: Residence [* Apartment House ❑ Commercial ❑ Trailer Court. ❑ Motel ❑ Other ❑ Number of living units-.!------- Number of bedrooms __Z___ Number of baths ___l__ Lot size -----clC__:_x---2 fl--- -- ------------------ Water Supply: Public system] I Community system E] Private [31 Depth to Water Table3.5____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes.T] No ❑ FHA/VA: Yes ❑ Noj] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from l nearest well_________________Distance from foundation-------------------Material---------------------------------- -----..______- [XxiSting No. of compartments------------_-------------Size--------------------------------Liquid depth---------- ---------Capacity----------------- --- Disposal Field: Distance from nearest well---------- ------Distance from foundation--------------------Distance to nearest lot line________.--_._.._ [ X8t3IIg Number of lines_____________. Length of each lin e-------,-�_�__-___Width of trench______ ��_.____.____ 7f a.,V Type of filter 'material__ ,� / Depth of filter material___ff ______-- Total length---------3_C1____________________ -' � 4 c11C Seepage Pit: Distance to nearest well------ Aql------Distance from`foundation____ C...___-_.Distance to nearest lot cine---- _t_--__--_ r Number of pifs Lining material____P.Ck_.._ Size: Diameter-------33_11._-_-__-Depth_25.1______________________ G q Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_.-..--.--_-____._.._________:_..__. ❑ Size: Diameter----------------•---------------------Depth--------------------------------------------- ------Liquid Capacity---------------------------gals. I -_Distance from nearest building Privy: Distance from nearest well. 9 ❑ Distance to nearest lot line----------------------------------------------- ------------------------------------------------------------------ -------------------------- e-a e--- 1'o._-10--OXO_t ng---BY- t eM--------------------- Remodeling and/or repairing (describe}:__--___$ d1ng g -------------------------------------------------- ----------------•---•--------•--------------------------------------------------•--•---------------------------------------------•--------------------------------- 1 --------------------------------------------------- -- -------------------------- ----------------------------------------------------------------------------------------- ----------- E 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. 2 i? A._s - e ;�1C--Tan—k_gerVie g _,,_ -I11C-1------------------------------------------------------------------Owner and [Signed}-- --D-----Yt � { or Contractor� By:---Rgrr_r--Q-+-- WArthan---------------------------------------------------------------------------------(Title)---------Gen, Mgr----- - --------------- -- (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 U REVIEWED BY------------------------------ -------------- -------------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------•--------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:----------------•------------------------------------•--------------------------••-•-------------•--••- ------ . ----------------------- -------------------------------_1------------------------------- ----•-------•---------------------------------------------------------------------------------------------------------------- ---------------- ------------------•---------- -------------------- ------------------•---------- ----•-------------------------------•---------------- FINAL INSPECTION BY:------ -� ✓�'=tom``' Date------------� -- Q " SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California FS.9-2M Revised S-'Si9 F.P.C..