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FO OFFICE USE: ------------------------ APPLICATION Ft—. SANITATION PERMIT Permit No.--------------- ---� C� -------- -------------------- {Complete in,Duplicate} --------------------------------------------------- This Permit Expires 1 Year From Date Issued Date issued Application is hereby rriade'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---------------------- 1SS- - C1ytgn-...... --------------------------------------------------------------------------- Owner's Name--------- Lo ron Robert$ Phon-- - --------•-•--------------------••--------------------------•------------------------------- .-a---•------•----------- Address------------------- 169 Elsworth:--•.San Fransci 'II` - •• ------ -----• ------------ ------------•---••------•-•---------• Contractor's Name------Delta___�eptic..Tank-_Sere'�c_e,.-_txa -•-----------------------------------------..-.. Phone..HD.....3:-12.6 ---- Installation will serve: Residence n Apartment House '❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1--- Number of bedrooms .-2_.. Number of baths ------I Lot size .---_.-.5-0-'-X140-1! h Water Supply: Public system] Community system ❑ Private ❑ Depth�to Water Table:51_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®` Hardpan ❑ • ►' Previous Application Made:' (If yes,date------ ------.------) No [21 New Construction: Yes K] `No ❑ FHA/VA' Yes ❑ -NoEA TYPE OF INSTALLATION AND SPECIFICATIONS: . } Ntr,W (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well----------------Distance from foundation--------------------Material --.--------------------------------------------- EX!�gtIng No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Cap acity-----------Y--------- , Disposal Field: Distance from nearest well-----------------Distance from foundation....................Distance to nearelp lot line----___.._-.----. Exuti.ng Number of lines--••-------------------------------Length of each line--------•---------------------Width of trench--'J U-_---•-------------------•-- i Type of'fi4er material-------------------------Depth of filter material-- ---- -Total length----------I----------------------------- t t 4 t Seepage Pit: Distance to nearest well---1QQ1--------Distance from foundation_---1q-_-_--___.DisBance to nearest lot line.-.5.1--- -N Number.of pits--------- ----- -----Lining material----1'Q_G .----.Size: Diameter--- ---------------Depth-.�I�1j------Ma$.------ Cesspool: Distance from nearest well-----------------Distance from foundation. --__-.-.-------.Lining material-------I------.-.-_...__-.--_----.---. ❑ Size:Diameter--------------------------------------Depth.-..----- ------------------------------------------Liquid Capacity... ---------------------.gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building I ------------------ ElDistance to nearest lot line----------------------------------------- -------------------------------------------- ��_-------------------------- i Remodeling and/or rewiring {describe):-------,��ding-Yllten b-ed---to---exi -t-Ing...ayatem--------I----------------------------- ------------------------------------------------------------------•------•----------------------------------------------------------------------•----------------------------------- ----'--------- 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. �I y (Signed) Delta Se t�ZL--1a ��-erPike,,---1na-.--------------------------------------------------------(Owner and/or Contractor) Per Warthan By: ------------------------------------- -- {title) Gen. 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 .II' APPLICATION ACCEPTED BY-------- --- .�..---------------------------------------------- DATE . - .-- --- -------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------- ---------------- DATE----------------------------�- BUILDING PERMIT ISSUED-------------------------------------------:...--------•--•-----------------------------------•---.. DACE----------------------------- Alterations and/ r reconendations:----=-------__ - ' --------•--------------•-----•-•------------ ------•------------------------------------- •------ --- ------ --------` `-------------- •---...--- - ----'-- -------_--I----------------------------• -------------------------------------- ------------ ------- - ----------.----------- ------------- ------------------------------•-----------------------•----------------------------------------------- . _I�---------------------------- . - II FINAL INSPECTION BY:-' 2=��"-------------------•------ Date - /--v - / �!' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodl,California Manteca,California Tracy,California l F'B•9 RcV16E7 8-69 Y.P.0O3 3M 6-60