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FOR OFFI E USE; a '7�� ,gyp . 711 _ �___________________________----____ APPLICATION FOR'SANITATION PERMIT Per No. _--_1_. -__ _ 11-`� - ----------------------- --- --------------------------- (Complete in Duplicate) Date Issued g............. b ------------------------------------------------------------ is Permit Expires i Year From Date Issued Application 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.-_-------Rt. 4------Box---98x .. . rd hou8e N. of Far min ton ftd C: Power on E. B�d-- �;hone a .. a 53Owner's Name -m and Lta-- --- - •---•---------------------------------------------------------------------------------------- --- . Address-------- .:BQx•-QS: -S kE nt------------- Contractor's Name. D. $__•rSe tiC_-.Tank Ser icer--jIIC.------------------------ --------- -- Phone Hq' .1!19(9. Installation will serve: Residence.® Apartment House E] Commercial E] Trailer Court ❑ Motel C] Other ❑ Number of living units: .1----- Number of bedrooms ----2-. Number of baths ----1. Lot size ---------------2�_-- ___--------_ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table 45--- ft. Character of soil to a depth of 3 feet: 'Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [3 Hardpan ❑ Previous Application Made: {If yes,date_----- -------------) No:K] New Construction: Yes in No ❑ FHA/VA: 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---------------.--------_---___----_---_------. a ExUtlng No. of compartments--------------------------Size--------------------------------Liquid depth--------------- -------- Capacity....----------------•- Disposal Field: Distance from nearest well-----------------Distance from foundation.-_--------.......Distance to nearest lot line_-------___-__-.- ExIn3ting Number of lines-----------------------------------Length of each line------------------------------Width of trench----.-----_-------_---------------- j Type of filter.material---------.--------------•Depth of filter material-----------------------Total length------------------------------------..__.. ! Seepage Pit: Disfance to nearest well-.A.W----__Distance from foundation-_-I-a'2------Dist Ince to nearest lot tine-----5_1P---- �] Number of pits----------1---------Lining material-----I'OGk------Size: Diameter----3_ -1------------Depth---25-------m x..-------- Cesspool: Distance from nearest well-- -------------Distance from foundation-------------------.Lining material-.----------_---------------_--------. ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------_--------__----_-_------. t ❑ Distance to nearest lot line---------r------=--------------------------------•---•-----------•-....... ------------------------------------------------------------------ Remodeling and/or repairing (describe):.----- d. illgn- Fidterr--Be_'_d---t0__ex�-8tiRg---B.yq. pm ; ------------------------------------------------------------•----------------------...--------•----------------------------------------------------------------------------------------....---•------------------------------- -------------------------------------------------------------------------------------------------------------------•------------------------•---..-._..--------------------------------f-•---•-------------------------------- } 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)--------------D 8�_.SPt -C-_.'I'&Illi ----- - s -- -----------------------------------(Owner and/or Contractor) By:------------p e3=,y---- -•----Warthin --------------(Title)--------- Gen.-- Ngrit---......... -------------- (Plot plan, showing size of lot, location of sys latio wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- --------- ---------------------------.........------------- DATE--- �� --------------------------------- V REVIEWED .BY------------------------ -6 ------------------------------------------------------ DATE----------------------------------••------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------•--------------------------------------- DATE---------------------------------------------------.--------- Alterations and/or recommendations:-------------------------------------------------------------------------------------------------------------•-------------------------------.------------ ----------------•-•----------------------------------------- --- -----------------•---------------•------------------------....-•-------------------..-.-. -. ---- lM1 - r � 4---- `�` 'r- ` -----,- c its---------- --------------------------------------------------------------------------- _N -..-. ------------------------------------------------------------------------------------------------------- ------------------------------------------------ ------------------------------ FINAL INSPECTION BY:...... Dater! �7(....... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 91h Street t Stockton,California Lodi,California Manteca,California Tracy,California i Ee-9 REVISED 6.59 P.P.DD.3M 6-sd k