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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) �� Date Issued __ __ �k_1 Application is hereby made to the San Joaquin Local Health District-for a permit t cxtructland install the work herein described. This application is made in compliance with County Ordinance No. 549. r - 1 ]oa JOB ADDRESS AND LOCATION___________2504 Delano � / Owner's Name R. McKee ------------- Phone__�'^��D1--.-•--------- Address---------------------- G4 Delano �. - ------------ - -------------------------------------••-------------•-•---------------------------------------------------------------------------------------------- Contractor's Name______________________________ Delta — --•--------------------------------------------------•---------------------------------------- Phone - ---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms -2---- Number of bathsZ..------ Lot size ----1-67x._7,5----------------------------------- Wafer __________________- _.----._Water Supply: Public system ❑ Community system ❑ Private M Depth to Water Table 10-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel p Sandy Loam ❑ Clay Loam [❑ Clay [❑ Adobe ® Hardpan ❑ `k1N, Previous Application Made: Yes ❑ No [j New Construction: Ye's [3 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: `----� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep® Tank: Distance from 'nearest well 1l e - 1undatial =_ CNo. of compartmets- 2Distance 1431- ---- --- - iX - �? Disposal Field: Distance from nearest well___ -------Distance from foundation 0 ----to nearest lot,ine___-__3r ® Number of lines_____________ ______________ _____Length of each line________ a Width of trench-- � ___..____________________ Type of filter material__rDCk Depth of filter material-__-__-__1------------Total length------------------------------------------ Seepage _________________________ _ _Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest [of - line________________ ❑ Number ofpits_____________________Lining material_____________________.Size: Diameter_________-_--__- -------.Dept ----------------=---------------- Cesspool: Distance from nearest well----------------- from foundation---------------- __Lining material__=_=_--�_______________________T- - ;. r_ .. :_ — ❑ - .. , y . Size:.D.iameter---.-------------- --------Depth---------------------------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well----------------------------------------------------Distance from nearest building_____.________________________._____-__ ❑ Distance to nearest lot line- ----------------------------------------------------------------------------------- ------------------------------------------------------ { Remodeling and/or repairing (describe)_------------------- I✓_W-__ay-is_t-em------------------------------------------------------- Il' ---------------------------------------------------•--•---------------------------------------------------------------------------------------------------------------------------------:------------------------------------- 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. I (Signed) D+Kl a----------------------------------------------------------------------- ------------------------------------------------ Owner and/or Contractor By---------------------Perry WarlhaA-----e0,-- --- Title Owner-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 I APPLICATION ACCEPTED BY--(2------------------------------------------------------------------------------------------ DATE_�--------• ---------------------------------------- REVIEWED BY--------------------------------;?�; t DATE__ -----------------_--------------------- ------------------- --------------------------------------- BUILDING PERMIT ISSUED-------------- ,- -------------------------------- --------------------------------- DATE----- Alterationsand/or recommendations------------------------------------------------------------------------------------------•---------------------------------------------------------------------- -----------------------•---------------------------------------- --------------------------------------------------------------------------- ---------•-------•---•------'---•---- -A----------------------------•---------- = .d! -f----C�-,Crole- -------------------•--•-•------•--- -----------------------------------------------------------------------------------------------------------------------------------•---------------••-- ------------------------------- ------------------------------- ------------------------------ ------------- ----------------• ••------- -------------------------------------------------------------------------------------------------------------------_--------------------------------------_--------•-------- A--------------- Date-------- - . --------------------- FINAL `INSPECTION BY----------------------------------------- - -�- ��------------------ 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 ES-9-2M 8-51 Revised W-2100