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k APPLICATION FOR SANITATION PERMIT Permit No. -_r?- (Complete in Duplicate) _ Date Issued ---- Application __Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ,r This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION ' LOCATION...._R " �nA Owner's Name-------------Xr' ayjd--�TjrQ-' -- �a ---Q011aervll1q---------------11---------I-------------------- ress .s _ - ----------------- ----------------------------------------------------------------------------- Phone---9-°3 ---•- - g ------------------- Contractor's Name-----------Del�,a ------------•--------------------- ----- --------------------------------------------- 3-3955 Installation will serve: Residence ® Apartment House ❑ Commercial L1 , Trailer Court ❑ Motel ❑ Qther ❑ Number of living units: -1--- Number of bedrooms -2---- Number of baths ..1--- Lot size Water Supply: Public system ,-"" _"_ c�"e E] Community system ❑ Private [2 Depth to Water Table -------- ft Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam ❑ Gay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: Yes ❑ No a New Construction: Yes 0 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Dstance from nearest well---.._4040'---Distance l® from foundation._-.8r------------ " Material No. of compartments_.___" _- """__ 2r -----Ce _e12tr-hr_iGx-------- ---Size_ Disposal Field: Distance from nearest well.. D .. -------Liquid depth5-r-&-3--i----- Ca ac ___SQO------------ _-..__.".___ istance from foundation--------------------Distance to nearest lot line_._.."____..___.. ❑ Number of lines-----------------------------------Length of each line------- Type of filter material------------------- Depth of filter Width olength trench -------th_._.-"""__"_"_---------------- ---------- .. material---""_"-- ------_ Total ------------------------- Seepage Pit: Distance to nearest well_ '7.__..-_ ._5--------r�M Drstance from foundation---- Q_1__,------Distance to nearest lot © Number of pits-----------1--------Lining material____brJ,Ck----Size., Diameter �I ----,Depth---2Q- 1--- -------------- 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------------------------------------------ n Distance to nearest lot lineRem eling and/or repairin (describe:-----N -�--S� �0M--S -- - '----------------------------1-------------- -------- --------------- --- t ----- ------------ / e V ---- = ------ --- h �,4_� -, - -rr _ ` .-. v ------------f - ----- ereb ;certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----------------De-It.a------------------------------------------------? ---" -" (Owner and/or Contractor) By:----------------------------Fe-2my---`dar-tharA----j-.-�-_ . -------------------------------------------(Title)-----4�rner-I�i�r-'-- ------ (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 , REVIEWEDBY--------------------------------------------------- ------ � __ v= -- ---------------- --- --------- ------�-------- ------- ----------------------- DATE------------- --- •-----� BUILDING PERMIT ISSUED----------------------------------------------------- --------- -------- ---------- .----�------------------------- } -----------------------------•---------------------------------- Alterations and/or recommendations:._.............. DATE ............................... -- ...---- ._-__-_--- 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 FS-9--2M 8-51 Revised W-2100