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R SANITATION PERMIT Permit No. --- 3__�_-. APPLICATION FOR a (Complete in Duplicate) t 'Date Issued _ l C/O._/=� _� � .-1� « +.wyn�..w-�.k:m w It 5,.R waw+d'•!.'.1..�r.. �w�o.+i� -.._ ..� -f - Application is hereby made to the San Joaquin Local Health District for a permrt'to construct grid install the work herein described. This application is made in compliance with County Ordinance No. 549. • .. 4_IL A-V ., s *� JOB ADDRESS AND LOCATION-------- -_T 2' a -Ch�POkeB..-L4n@----------------------- ! Lois Northin ton and Marvin Henderson.. _.,� .,� ^PhoneJfq.A_'_-.1,-531_ Owner's Name --------=-----------1 ---------•----•------------•-----------------------7---------------------- - -- ---- ---------- Address 2420 Cherokee La-e ----------------------------------------------------- --------------------------=---=--------------- -------------• --------- Delta,..-Inc. - 3 7727 l Contractor's Name ---------------------------------------------------------------------- Phone_HO•- Installation will serve: Residence IN Apartment House ❑ Commercial ❑ Trailer Court ❑ -'Motel ❑ Other ❑ Number of living units:l:----_ Number of bedrooms _- _-- Number of baths __ -_- Lot size -----?0-.k--1OQ-------------------------------- I Water Supply: Public system] . Community ,system ❑ .Private ❑ Depth to Water Table --4-5_ ft. ' -:' { Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay (] Adobe K] Hardpan �-� Previous Application Made: Yes ❑ No ® New Construction: Yes ] No ❑ FHA/VA7-fes ❑ No ❑ .. I I 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--------- Ey-ling No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity--••------------------- ; I Disposal Field: Distance from nearest well-----------------Distance from foundation----__-------------Distance to nearest lot line_--____.- -_._ ExL4~ ing Number of lines-----=_----------- -------Length of each line------.-----"-----------------Width of trench.---------------------------------- T e of,filter material-_-----2 -- --.l_De th of filter material_-_-'--____-__------Total length--------------vim._____---__----------- ! Yp � A Seepage Pit: Distance to nearest well_"' -7 t --Distance from foundation___ 0DIa Distance toneates' r___._.. --,• _ of line--fes-=31�° Number of its_____ ..-. material-_r-Q-Ck- -___--.Size: Diameter-:,---- n p r� __ pits - g 0, 1 CCesspool: Distance nearest wellDistance from foundation--- material---'- esspool: .,_ ------------"----. i S- . iameter--------------- ----------------------Depth------- ------------ -----------------------------Liquiiid-Capacity---------------------=als.\ Privy: Distance from nearest well------------------!__-__-------------------_-----Distance from nearest building____-_------------_----_----________--. ❑ _ .-Distance to nearest;lot line------- ----------------- "= = ----=---------_• ---- ----------------------------•----------------------------=----------. {f emo eling. and/of repairing (d scribe):-----------Addie .---aeepme---P� ---t0----Qx-1-a-ting---6,V-131em------------------ ..------- :� = � -- ,. . ' �. ---------------------- --------------------------------------------------------------------------- -------------—----------------------------------------------- -----------------------------------------------t - I hereby certify that I-have,prepared_Ais_applicat.ion and:that-the-work-will be done in accordance with San Joaquin County ordinance State laws, and rules and regulations of the San Joaquin Local Health District., Delta----Inc---------------------------------------------------------{---------- ---------------------- -- Owner and/or Contractor (Signed)---------------------------- -----t ( >I ) By: F' W-•----------- y --------------------------- ---------------- -------------{Title] Gen-,'.fir-4--------------- -------------------- I (Plot plan, showingsize of lot, location of system in relation to wells, build in s,�etc., can be placed on reverse side). - FOR ARTMENT USE ONLY - F 9 i APPLICATION ACCEPTED BY------------ ------------------- "} - - DATE------------------------ ------- ---'-' - `---- ------------------ DATE---•-------- s �/ -•�--L----------------- ! REVIEWED BY----- ---------------•----- li------------------------- -------------- - �_--- BUILDING.PERMIT ISSUED------------- DATE = Alterations and/or recommendations:--------- _. _--= ---- _ =` ==` _-------- ------------------- --------------- - -- ------- �- e ------- - -----------, 7----)_e�-------�<� �.�T----:-/---��. - ..-_----- _--- �1 _- ` �---- _nom f --------- =----- - - ------------ ------------------ - ------- -�-'� t�=- �/ ' FINAL INSPECTION BY-- ---------- - --,]�,� --_ -- - . Date-' ---_------'---D..:-------- SAN JOAQUIN LOCAL HEALTH DISTRICT V 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-7-2M , Revised 1.57 F.P.CO. "