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\0 4 APPLICATION FO,.Y.jANITATION PERMIT Permit No. ._tA 7--______- (Complete in Duplicate) r 79� " " 7_121.71sC Date% Issued ------------ --------- A 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. JOB ADDRESS AND LOCATION......_2 bb -FunBton, - --------- n------------------------------------------------------------------------------------------------------------------- Owner's Name------ Danner ----------------------- Phone._H!?o_3_""773$---�".r .--Br14- 9 F1lle-,__-Calm'.----------------------- - Mr. Jack McMahan Address------------•---•--•-Cobbs- - - - - ---------------------------------------------------------------------------------------------- Contractor's Name----------Pej.-tvL--Septic•--Tank---Ser iCBA---SnC:------------------------------------------ Phone--H!?.* Installation will serve: Residence;K] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I--- Number of bedrooms A— Number of baths _-_-I__ Lot size --- Q__x._l,Qfl__________-._________________-- Water Supply: Public system X] Community system ❑ Private ❑ Depth to Water Table 35--_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [j-' Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ { Previous Application Made: Yes ❑ No ® New Construction: Yes [X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: h (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_---------------Distance from foundation-----------------__.Material----------------------------------___-.---- Exioing No. of compartments---------- ----- ------Size---------------•----------------Liquid depth-------=------------------Capacity-------------------- Disposal Field: Distance from nearest well.................Distance from foundation.---_-__________....Distance to-nearest lot line________-______-_ Exioing Number of lines-- ---------------------- ---------Length of each line-------------------------------Width of trench----------------------------------- Type -------------------_. _ -Type of fi#ter material-------------------------Depth of filter material----------------------- otal length_________ --------------- ............ Seepage Pit: Distance to nearest well--_-__n0----------Distance from foundation_lfl_E___...:___.Distance to nearest lot line------- , Number of pits------!-------------Luning material----- Diameter-------3Op_------Depth-----------91?_.____---__ ----- k Cesspool: _ . Distance from nearest well-----------------Distance from foundation------.-------------Lining material__:------------------..-_____________-_. ❑ Size: Diameter------------------------ ------------De,pth-----------------------------------------------------Liquid Capacity-.--------------------------gals. 41 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----__--_----------_--______-----_-______- 0 Distance to nearest lot line---------------------------------------------------------••------------- --------------------------------------------- Remodeling and/or repairing (describe):-------------------- aaM e86 @ it tO eXlatin 8 BtCIA -----------------------------------------------------------------•-1-------------------------------------•-------------------------------------------------------------------------------------.--------------------------- -------------------------------------------------------------------------------------- --------------------------------------------------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. (Signed)---------Ae1t_a__AeP?ti_0---T.aak.-__3_erv1Cep---Inca.-s-------------------------------------------------------------(Owner and/or Contractor] By:-----------------RA-Yo-------------------------------- ---------------------------------------------------------------------(Title)-- 91E! -*149r*-------------------------------------- (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"t�-� REVIEWED BY------------------- ------- ----- - DQE- . -. BUILDING PERMIT ISSUED------- ----•-— - DATE - s�.. Alterationsand/or recommend tions----------- ---- -- --- ---....._.....---------------••--•----•-•---------------------•------------------------------------------------------ ✓I�' � r _ 1, -------------- -- --------------------------------------- ------------ ------------------ - � --- -- -------- Date . � .� ----------------------- FINAL INSPECTION BY ---- -=-- -- - -• -- - - - SAN JOAQCii1V 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 E8-9-2M 14S446 ATWOOO 12-54