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1,lf APPLICATION FOR _ANITATlON PERMIT Permit No. . _ ............ (Complete in Duplicate) Date issued Applicaa-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, JOB ADDRESS AND LOCATION---------1006--5.._cul Van Owner's Name----------------------------Hcrman Christenson Ph 3- '73 ----------------------------------------------- ................................ ---------- Phone ----------------------------------- Address h Address-------------------------- a _. H2sr son Contractor's Name---------_----------- PS -------------------------------------------------------------------------------------- ----- --------- Phone_.- - -- 2l� --------------- Installation will serve: Residence Apartment House [_] Commercial F] Trailer Court ❑ Motel ElOther ElNumber of living units:______ Number of bedrooms __2--- Number of baths ._2__ Lot size __5Q._.K---1. 0---------------- ------------------ Water Supply: Public system] Community system ❑ Private 0 Depth to Water Table AQ_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: Yes ❑ No [9 New Construction: Yes ] 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________-___.__-_-_-_______.._________________. eXi:61E�ng No. of compartments--------------------------Size-------•---•--------------------Liquid depth..------------------------Capacity------------------ Disposal Field: Distance from nearest well________________Distance from foundation--------------------Distance to nearest lot line_____--_______-_- exlet]]ng Number of lines-----------------------------------Length of each line-------------------- -------Width of french Type of filter material------------------------- of filter material--------------.--------Total length-------------------------- ---------------- Seepage Pit: Distance to nearest well------I10-----------Distance from foundation____ I...........Distance to nearest lot line , f [ Number of pits______1_____________Lining material-______br brick Diameter___.--%._.______- r-- Depth -•• ----------- Cesspool: ------ -- 0 Cesspool: Distance from nearest welt-----------------Distance from foundation--------------------Lining material_-_____-.___.___.______,•_______- p ❑ Size: Diameter--------------------------- ----------Death---------------------------------------------------Liquid Capacity----------------------------gals, 6 Privy: Distance from nearest well-------------_-----------------------------------Distance from nearest building----------------------------------------- V% ❑ Distance to nearest lot line Remodeling and/or repairing (describe)___ __________`'A_adlT1g_ SeCpB a pit t0 existing sentiC system V' - -------------------------------------------------- -----------------------•--------------•---------•-------------•--------------•-------- ---------------••---••----------------•-------------•---------------•------•-•-•----•-•--------- -•-- -------------------•---------------------------------------....----------------------------------------------------•---------------•-•---------------------------------------------------------------------•---------------- G I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County P ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------D —--�-'------•-----•------------------------------------------------------------------------------------------ --------------------------------------(Owner and/or Contractor) By:----------------- --Warthan.------------------------------ ------------(Title)---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--------------------------- -- - -- ------------------A-4------------------------------ DATE-----------------f = REVIEWEDBY-----------------------------------------------------------------------------------------------------------------°_----------- DATE--------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations:------------------------4---------------------r----------_---------------•------------ ----------------------------••-•-------------- -•-------•------•---------------------------•---------------------------- --------------------------------------•-----------------------•----------------------------------- --------------------------------------------------- ---------------------------------••--------------------------------------------------------• -•--------------------------------••---------- I / / !.-, Aft_ele4 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 ES-9-2M : Revised W-2100