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APPLICATION FOR SANITATION PERMIT (Complete in .Duplicate) T - 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. dos—t_Za -0 JOB ADDRESS AND LOCATION----Rt_.__2,____ nx___�7$ _.-------2nd---ho-us-e--- --•--- c--N_----side Owner's Name------------GjeC,-t_-QS_9_rto 2-s---At-------------- ------------------------------------------------------------------------- Phone-----9-6-018__Lodi-- GAddress--------- ----48-3-s----Ai_aap_a_,___Ci_a_.1f+--------------------------------------------------------------------------------------------------------------- fC;ontractor's rName-------D-elt-a-------------------------------------------------------------------------------------------------------------------------- Phone-_3T39-5-5------------- Installation hone- --3T-39-5-5------------- Installation will serve: Residence KI Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ kA Numbei--of living units: ® Number of bedrooms ® Number of baths M Lot size-----2'__5y,1_ '-____________________________________4 � • 41 Water Supply: Public system ❑ Community system ❑ Private []C i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardparj05.�- I TYPE OF INSTALLATION AND SPECIFICATIONS: �' (No septic-tank or cesspool permitted if public sewer is available within 200 feet.) �Se tic:Tank: _ i]istance-from-nearest well___ ________! ------------------------------------- 7 __ - -- IS`�G `" No. of compartments-------- 2 Capacity--- ---Size----------? ----------------Liquid depth------? ------- Cesspool: s Distance from nearest well-- _-_Distance from foundation____________________Lining material-____._________________________ ❑� Size: Diameter--------------------------------------Depth--- ----------------------------------- ---------- , a � Privy: Distance from nearest well_________________________:_____- - _.._Distance from nearest bu !ding_________.____.___________ Distance to nearestlot line_Iva( Seepage a e P�.:,vl Distance to nearest'welt____ ----------- from foundation________.a_--__-Distance-to nearest lot line_------f __` YC Num6er of pits________l Lining material----br'1-e ----Size: Diameter__,__________________Depth----25 "� i9: L3istance fr ni4neares#:well.5�=.Distance-from..foundation__.-+ .Q_��_XD.istanee-to Barest,lot ! ria KING Number of lines-------I------ --------- --_ _Length of each line---_75_-------------------Width of trench------ ___---.-------------------- Type __.____._.Type of filter mate ria!__ ---------------Depth of filter material____!Z________________ Remocleling`and/or re '",-airing (describe):-------- --------------------Tris eat,ling,�- -mew--__-ve-rt:1_c&-i.._dr'aim-_QSi__-end---af ---- th�t-e �,x�s�- �.€�__3.� �_-ora_�n---and---�hoOking--v-p-.ta---e_xi.s� r� � g---1e-ach_dr_ain.__�r_ith__so_lid---l-a-r�- � ^" y - r y ha have p-- pared this application and that the work will be done in accordance i -- - my hereby car+if that 1 have re rdance with San Joaquin County a ordinances, State laws,:and rules and' regulations of the San Joaquin Local Health District. (Sighed)--------`-Dalt,_a---------------------" ----------------------------------------- ---- ---------------1---f-------------------------------------.-------(Owner and/or Contractor) •BY:---------------------X-erry_ Warth. --=------------------- ----------------------------------------------- Title----- 1trier-" l r '+---------------------------- 6-04 ---------- ------------ �- ._ ._ - � .. �.. _ _ �-µms.__. - (Plot`pl�s, sh-owing size of lot_locatib�n"of system in relation to wells;huildin'gs"eic.;must be filed withthis application]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-V # ------- DATE-----— _____________-------------------------------------- eA __ a REVIEWED BY------------------------------ ---------------------------------------------- - - ----:---------------------- DATE-___ -BUILDING PERMIT .ISSUED------- ---------------------------------------------------------------------------------------- DATE . Alterations and/or-recommendations-------------------------------- - -.----------------------------------------=------------------------------ ---------------------------------------------- ----------------------------------------- -:------------------------------------------------------ ----------------------------------------------------------------------------------------=------ - �' ---------------------------------------------------------------- -------------------------------------- ---------------------------------------------- -------- M PERMIT N6/_V-1'"V ISSUED--------- 3 (Date) FINAL INSPECTION BY:----------------------------------------------------------------- ---------------- � -' 1 Date--------------------------=-------:--------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ! 130 South American Street Stockton, California ES—__.'''M 9-50 W=1639 fe