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\V! K APPIIICAT'rON FOR-SANITATION PERMIT Permit No. (Complete in Duplicate) G n This Permit Ex ires 1 Year.From Date Issued Date Issued ---- ---- 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. JOBADDRESS AND LOCATION......._175 --South_ Drake------------------- ------------------------------------------------- ----------------------------------- Owner's Name Rpg- I`- & Maria--Caeil1_as ---------------- Phone_H_!t ---- �JBE?-I'----- ------ --------------------------- 75_4--South--rake --------------------------------------------- Address De _ s 3e_tic Tank Service enc. Phone_H°--_-------?72----.- Contractor s Name----------- �1-----• ---p- --- Tank Service. :-Inc.n Installation will serve: Residence$] Apartment Douse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __a---- Number of bedrooms __9... Number of baths _-.1-- Lot size ...... ---x---2$-d--------------___--..------ Water Supply: Public system E4 Community system ❑ Private ❑ Depth to Water Table _5. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yesj] No ❑. FHA/VA, Yes ❑ No [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 --.-----_.---.--..____.------------------------ 1A Exining No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Disfance from nearest well.--------------_Distance from foundation--------------------Distance to nearest lot line-----------...... Exiting i Number of lines-----------------------------------Length of each line:--------------------4-----.--Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material------------------------Total length-----------------------.-_ I Seepage Pit: Distance to nearest well---------ua------_Distance from foundation----_�01----__.Distance to nearest lot.line-_._��---_----- EX Number of its______ Linin material-------_--------------Size: Diameter- ----.-- ----.-------Dept`r,__2-.-"' t�--_ CilIOX� rock 33 5 Cesspool: Distance from nearest well-----------------Distance from foundation-_-----------------Lining material----...--------------_--._-_--_-----_ ❑ Sze: Diameter------------------------- ------------Dep}h- ------------------ - ----------------------------------------------------Liquid Capacity-- ------------------------gals. Privy: Distance from nearest well---------- ------------------------ ------Distance from nearest building.--------.----.---------___-----.__..__-- I ❑ Distance to nearest lot line--------- --•----------------------------------------•--------------------------------------------------------------------------------------- Remodeling 'and/or repairing (describe):--------- dding---s epage---pit___ Fexisting systemt ------------ k ----------�---------------------------------------------------------------�_:--------------------------------------------------------------------------------------------------------------------------- ............ I -----------------`--- - -- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--`-----------------Delta---`-vn is--- MX_ SerY Ce-..._In.Ca-�-------------------------------------------------(Owner and/or Contractor) t Qen� M r�------ ---- - ------- ---------- By• - 'Erry OliVer__Warthan (Title) g (Plot plan, showing size of lot, locaflon of system in relation t6 wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICAON ACCEPTED BY-------------------------- ---- ---------------------I----------------------- DATE-------- {.d��--------------------------- DATE REVIEWEDBY-------------------------- --------------------- - ' - - ----- --- ------ ------------------------ - -------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------•-------------------------------------- DATE---------------------------------------------------------- Alterationsand/or-recommendations=------------------------------ ------------------------•-••--------------------------•-- ---------------•-------------•----- ---------------------------- - -------------f --------- tit ------------------------------------------- --------------------------- - ----------------------------------- - - ---- --------------------------- - -- ------------------------- --- FINAL INSPECTION BY:- -- -- --- - ------------------- ------ D8te__.A6/ ---------------------- ------------------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street e14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California rt ES-9-2M Revised B-'59 f.P.Co.