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111.E APPLICATION FOR -ANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued jApplical-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. is application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----------------------- _7. __E•__-Pinchot - Owner's Name---------------------- Lulu Cray 'ord Ho- 3--3b03 -------------------=---- ---- --------- Phone----------------- ------ --------- Address..................------AM.__AM._C ----------------------•---•----•- Contractor's Name-------------•---D el t-a Phone 3-3_9_5_5 Installation will serve: Residence El Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1-- Number of bedrooms 2----- Number of baths ---;-- Lot size ------s0--x_-.1-0-0------------------------------- Water 0__x__ -00__________________.__________-- Water Supply: Public system ET, 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 [Z New Construction: Yes K] 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------------------------.__-_____________--__--. ❑ exp s 1;irtgb- of compartments--------------------------Size--------------------------------Liquid depth---------------------- __ pati Disposal Field: Distance from nearest well .-Distance from foundation--------------------Distance to nearest lot line______________-.- eOLsting 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_-----nq ---Distance from foundation----Ap__. ----..Disr)ce to nearest 11lie_•-_5..------ .. Number of pits-----------Z-__----Lining material.....0Rjgk-_-Size: Diameter-----------------------Depth--.------ -�:--.____ Cesspool: Distance from nearest well_________________Distance from foundation- ---------------. Lining material--------- __--________________--___-_ w. ❑ Size. Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. } Privy: Distance from nearest well____---------------------------------------------Distance from nearest building__________-__-___------______.___.___._._. ❑ Distance to nearest lot line--------------------------------------------------------------------------•---------------------------------------------•-------------------- 4) Remodeling and/or repairing (describe):---------------------Aad!ng---srcrst sr c__-pit to existing _S CDL .0 System6 fn ------------------------------------------------------------------------------------------------------------------------------------------------------------•---------•------------------------------------------------------ ---------------------------------- ----------------------------------I---------------------------------------------------------------------------------------------------------- ------ 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. k (Signed)---------------------- ------------------------------------------------------------------------------------------------------------------------------(Owner and/or Contractor) By:--------------------------------Perry Warth�t1 (Title)-MF�' ------------------------------------------- (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--=fes-------•------------------- ------•------------- REVIEWED BY--------------------------------- --------------- ----- -- DATE------------ ------------- -------------------------------------- PERMIT ISSUED----------------------------------- ----------------------------------•------- --- ------- DATE------------1-1---- Alterations and/or recon endations--- ------------- - ---------------------------- ---- --------- ----•---- ---- ---- -------- .. -------------------------------------------------- - - ---------- --------- -- - ------ ---- - ----- --------- -------------- ---------- --- ------------ --------------- ----- --- •----•------------=------- ---- ------ ------------------------------------------------ ----------- ---------------• --- --------------------------- ------------------------------------------------------------------ - = - 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 E5-9-2M Revised W=2100