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�4 APPLICATION FO.. ,'ANITATION PERMIT Permit No. __.f -_ (Complete in Duplicate) /p Date !ss , ued ---- �-- S Application is hereby made totthe San'Joa uin Local Health district for pp Y q permit to construct and install the work herein described. This application is made in coripliance •with County Ordinance No. 549. JOB ADDRESS AND LOCATION------------3.004 Phelps , Owner's Name--- --- -ROl3A80n s , `T : - - ---------------Y; _:--- -„: -------------- ---------. :.:;--:----------- -----. Phone---na-..P B_e--------- Address----------------------3ob4.-map Contractor's Name---- ----• D!8! _AePt q Tank_gerY. CA-�; !;P!;* ------------:--------4-•-----------•-------. Installation Phone---HO+•-- _-727 will serve: Residence A ar#ment House r [5 p ❑ ' Commercial ❑ Trailer Court El Motel ❑ Other ❑ Number of living units: -�,".-- Number of bedrooms _�__"- Number of baths _-�:_- Lot size �0__-�---15Q_.:•,---_-_ _____ __ 3 - Water Supply: Public system' ® Community system ❑' Private ❑ Depth to Water Table .35- ft- Character of soil'to a depth of.3 feet: Sand _Gravel Sandy'- Loam Cla Loam Clay P z ❑ ❑ Y� ❑ y ❑ y ❑ Adobe Hardpan ❑ 1 Previous Application Made: Yes E71—No ® New Consfiruction: Yes ® No ❑ ^'+FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is:available within 200 feet.) # . , a Septic Tank: Distance from nearestDistance fromj-------------------- foundation Liquid depth Material ----------------------•- "----- ^+: p Size-- = q p --------------------------Capacity.---- g p Dis osal Field: i Dotance fromrnear st we4-- ----_-..Distance from foundation-:�----------_-_Distance to nearest lot line______________ ExisMing Number of Imes-------•---------------------------Length of each line----------------------------.Width of french Type of filter material---------------------- + Depth of filter material-__.-- '----"_--_--_--Total length----------_------- ------------ Seepage ---------.._----- te"" `"�"•*. See a e Pit: Distance.to nearest well_--_110 --R-;pis in'c-'a .. n I P 9 Mance .from foundation---- Distance to nearest lot line._-8!_ple ® Number of pits-----I--------------Lining material___I'OO$-------Size: Diameter'-28.0------------.Dep t ----- Cesspool: Distance`from nearest well-:___-" Distance from foundation------------- -----Lining material------------------------._--_- ❑ Size: Diameter--------------------------- ---------Depth----------------------- - = '= Liquid Capacity 9afs. ;' Privy: Distance from nearest well-------------------- --- "- -------_Distance:from nearest buildin ❑ Distance to nearest lot-line--.__- -..-_: "----__ - .. -'�.,.,,_ --------------------- Remodeling and/or repairing (describe]:--- ------------8ddl:69----6.eeP-(Ke__P _t-- tQ---Ftx'isting---aXa .-... . 3 "-___--__-.__"-------------------""-___---_____._______----_""--_-______-_--.._-_--__------_--.._-------_----___ l - 1. c -------------------- --------------•--------------------------------------------------------------•_------_------_-_-----_--•-"-_--•-__--_----_--_-----------------------------__--_.----------_------__-------_------------------- .....__” I hereby certify that I have prepared this application and that the work will be-done�i.n accordance-with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed}-------- •t' t8_.Ae�t:L1 r L caner and/or Contractor) ------------------- O By: P Erry- W6.rfiha>Gi '- Title Ca Ert. M r, or { } g -------------------------------- (Plo+ plan, showing siie of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------- h------------------------------- DATE ---------------- --------•----- REVIEWED BY w.. -- ---- -- --------, ----------------------------------- DATE------------- - BUILDING PERMIT ISSUED f. f DATEIf ----- - -- --- Alterations and/or recommendations:-- ; ---------- --------------------•-------- - ---- ------------------ --------••---- -- -----------------""-""---y-""-.-"------ ---'. - -/_ ------------------ ------I-------- ------------------------------- - ; ;1 -------------------------------- "[.r ---------------------------------- ---------------------- ------------------- --`------ -------------------------- FINAL INSPECTION BY:--- 7r/t e Date _-_ -_ /Y9 -------- 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-9-21v1 Revisea 1.57 F.P.CO.