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ANlTATlON PERMIT Permit No. ..g S_S ! -••----- � APPLICATION FO , Com (Complete in Duplicate) p p } Date Issued Applica*ion 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- 15�1 Ell at { JOB ADDRESS AND LOCATION------------ ---- -------------------------------------• ---------------------------------- ----- Ho, 24.3016 ' Freda -- . Phone-----•-----•----------•------------- Owner's Name__________________________ - - -------------- --- Address---------------•--------Z469---F+----W11 r W--------------------------•-------------••-•----------- --- -------------- -------- o ---5 Delta Inc. 33955 Contractor's Name-------------- Phone_HDe... Installation will serve: Residence Pq Apartment Nouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.___ Number of bedrooms 2..___ Number of baths .3----- Lot size.________SOxl Od _ Water Supply: Public system ] Community system ❑ Private [I Depth to Water Table 45__ ft. 3 Character of soil to a depth of 3 feet: Sand F] Gravel 171Sandy Loam [IClay Loam ❑ Clay E] Adobe a Hardpan E] Previous Application Made: Yes ❑ No{]'a New Construction-. Yes 5 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,$e tic ank: Distance from nearest well----------------- Distance from foundation--------------------Material------------------------------------------------- L'7Ct�1]gNo. of compartments_----- ----- ------------Size------------------------------ Liquid depth Capacity Disposal Field: Distance from nearest well--.--------------Distance from foundation--------------------Distance to nearest lot line___________._---_ Mxi®ting Number of lines-----------------------------------Length of each line``------------.--.............Width of trench_._._.------------.----------- -. Type of filter material_______________________Depth of filter material~`'______...-._.___Total length------------------------------ 1___..._ none 1 5 Seepage Pit: Distance to nearest well.....___ ____ ______Distance from founclation___�'�- __-__:. Vice to nearest lo$, _____-________--- ® Number of pits----- _--------------Lining material.__POC$-------Size: Diameter-:__,---- -- Depth------------------- ------------- O Cesspool: Distance from nearest well_-__-------------Distance from foundation-------- ----------lining'material-_-__.__.___-_--.._.__'T-_.-______- ❑ Size: Diameter------------------------------------- Depth----------------------------------------------------Liquid Capacity----------------------------gals. PrivDistance from nearest well-------------------------------------------------Distance from-nearest building----------.-----------------.------------ Y ' ❑ Distance to nearest lot-line----------------------- Remodeling and/or repairing (describe):....Aaa1?1 ,--3gf'}-a ,�------- #------ '------e>afisting---®yeets--------------•-------.----------•---- " ----------------------------------- -------•--------------------------------------•----- - --------------------------------•--------•-------•-------•--•--------------------------------------------------------------- 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 Sari Joaquin Local Health District. 1: (Signed) Delta Trina ---• ----------------- �-- ----------------------------------------------------------------1-.-(O and/or Contractor} g �------------------------------•------•--------- -------------- caner _ _"Gob. •Mgr. By:. Ferry---�arthan --------= ------------------------------[Titlel-----------•----------------------- ------ (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_: i ----._ DATE_ '--------- C -- - -------- ------------- ------------- REVIEWED BY 1 - ATE11 - BUILDING PERMIT ISSUED--------------=---------- --------------------------- DATE.------- ----------------------------- -------------------------------------------- Alteretions and/or or recommendations- -- -- ---- ='1 d --- -------- --- --:-1------ ._. ..' -------------- �- � -- _'"`'. -------------- - ----------------------- ----- FINAL INSPECTION BY:..-6,j-S- Date---3.-- -- 1-.7-4.1------ ---------------------------- ....... 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-4 145446 ATWODO