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1, APPLICATION FO►.._-.jANITATION PERMIT Permit No. .. G__5_ (Complete in Duplicate) �� Date Issued .__./215 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. 549:1 ` JOB ADDRESS AND LOCATION_____-____. 0.15--E.-__-6th st. , -•---------- ------------•----- -- ------------------•--•-----------•-------••--------------------------- ------------_--- Owner's Name----- 44;!'_Y -r 49MPBOI1 -- - --------------------- Phone. Address --_.Rt-'----1-s_--�OX__1 -2 AAS_•-Oak .B t -Ca11f. V1e Zetter -- .....------------------------- Contractor`s Name-------- tic Tank service,---Ines_-------------------------- h� - Ho= --�--=�269--- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer C Motel ❑ Of er ❑ Number of living units: 2----- Number of bedrooms .?_____ Number of baths . ____ Lo Water Supply: Public system [X' Community system ❑ Private p Depth to WaterQ__ ff. Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cley ❑ dabs[ Hardpan F]Previous Application Made: Yes El No [I New Construction: Yes KI No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sepfic Tank: Distance from nearest well________________Distance from foundation____.___..__-______ Material------------- ExiRin No. of compartments--------- Size ------Liquid depth---------- ---------5----.Capacity----------- ------ EDisposal Field: Distance from nearest well....-------------Distance from foundation--------------------Distance ,to nearest lot line_______---_-- xi ging Number of lines--:-------f---- = ---------Length of each line_.-----••------------------_Width of trench Type of filter material_------------__---------Depth of filter material___.__-`---------------Total length-------------- ---------------------------- Seepage Pit: Distance to nearest well ___--AO---------Distance from foundation_----10-- 1 Distance to nearest lot line_,_---5--_-_-_ �] Number of pits-------�..-___.-_.._Lining material__�Jx' C$.-.-_-Size: Diameter-------- n Depth---------25.------------------ Cesspool; Distance from nearest well____ ________Distance from foundation------------------- Lining material ----------------- --------- ❑ Size: Diameter- ---.:----------------------------De Depth - -- ------- ----Liquid Capacity- -------------------------gals. t Privy. rest well----------------- -------------Distance from nearest buifdin Distance to Weare Distance from nest lot line--------------------------------- -----------•----------- ----•- ---------_-- - ----------e- &� -m--- ----- Remodeling and/or repairing (describe)-------------------addig__see� ---------------------•------------••-------•----------- -----•------------------------ -----------------------•------------•---------------•----------------------•---•------ -------•------------•----------- e ------- I hereby certify that I have prepared this application and that the work will bdone in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----------- ei,to_-Sepc__.Tank---3ery ce,__Ince_---__ ---- -- ----(Owne'r and/or Contractor) By-----------------------------Perry--Warthan _ - -- - G - - ---- ----- --- -- - --------------------- ----- --- - -------(Title)------------en -- Mg.r' (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_ 1 ____-- DATE_ REVIEWED BY - -�-- ------------ I - ----- - ---------------------- DATE_' '' ------------ BUILDING PERMIT ISSUED------------- ---------------- -------------- ------------------------•----------------------------------------- DATE----- - --- Alterations and/or recommendations:._�------- -------------------- -__------ ----------- - ------ -- ---- ---- FfNAL INSPECTION BY:.---- _-- .--�- --t:--- -- ------------- - Date.._II� 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 Traey, California E9-9-21M 145445 gTWODO 12-5q