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APPLICATION FOR SANITATION PERMIT °� Permit No.A___--___--- -- (Complete in Duplicate) _ y Dots 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. l I -------------- te _ , --------------------------------------------------------------------------JOB ADDRESS AND LOCATION !I - Owner's Name---------��'.4�1__�p�_t�.�2_��es------------------------------------------------------------ - - ------------------------- ------- Phone--3-9979----------- 1 ------------------- IM Delta --- Phone------3-39-��--5----------- Contractor's Name________________ _____--_. ____ ' Installation will serve: Residence ❑K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other [] Number of living units` ____],_ Number of bedrooms ___2__ Number of baths _1---- Lot size ---------7-5x-50 Water Supply: Public system FK] Community system '❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth"lbf 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No [3 New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or ce spool permitted if public sewer is available within 200 feet.) Septic Tank: Distance1from nearest well-----------------Distance from foundation-----•-------------.Material-------------------------------------------- - EXISTUJ3G No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity--------------------- 7 Disposal Field: DistancelCfrom nearest well----------------- from foundation-------------------_Distance to nearest lot line--------------_-- Number f ___--___-__-__:_Number�of lines---------------.--------------------Length of eachline------------------------------Width of trench.---------------------___ Type of ;iter material_________________________Depth of filter material-------------------.---Total length------------------------------------------ Seepage _________-_-__-_______________-__________See a e Pit: Distance- nearest well---'-----------------Distance from foundation____--_____________-Distance to nearest lot line__________ 1 i m ___-__- -�k NumberioDth . : !1l Cesspool: Distance from nearest well_________________Distance from foundation-_--_-_______-____.Lining material------------------------.__..------- ❑ Size: Diameter----------------------------------=--Depth-----------------------------------------------------Liquid Capacity---------------------------gals. Privy: DistancJ11from nearest well________________tr_____-------------------------Distance from nearest building------------------------.___..------- El ____. Distancel.to nearest lotline-------------------------------------------------------------------------------------------------------------------------------•------- Remodeling and/or repairing (describe):----Inata-Ili nac _new--- ---aglz_.....40.L-!f t___________________ f ------------•----------------------------------'1'--------------------------•-•-------------------------------------------•-----------------------------------------------•••-•------------------------------------------ 'I -----------------------i:------------------- ----------------------------------------------------------- -------------------•--------------•---------•--------------------- - -------------- --------------------------------------------------------•-------------------------------------------------------------------------------------------------------- I hereby certify that I Dave 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. (Signed)-- � x°riTx IICi. Ae 5 _ Y 1G ----------------(Owner and/or Contractor) By:................•-•-----------j(_P.e_rry-----'Ka rt_laan-- // n— - ---------------------------------(Title)--------0_W ler!!XR1r_A----------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I �! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED; By DATE REVIEWED BY--------------------------------- DATE � DATE----------��----------------------------------------- - -------------------------------------------------------------------- BUILDING PERMIT ISSUED_1------------------ - -- Alterations and/or recommendations:---------------------. -------1M'--------------- ----- • -- --------------------------•---------------------•------------------------- ------------------------------------------------------------------------------------------ ------------------------•------------------------------------------------------------------ 6 . --- ----------•-----------,IG --- -•----------------------------------------------------------------------------------------------------------- --------------------------------------• ----------- ------•------- ------------•----------------------- FINAL INSPECTIG `, Y21- -___�------------------ --- ------- Date • SAN JOA QUIN LOCAL HEALTH DISTRICT 130 South America 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Califoi Lodi, California Manteca, California Tracy, California a f, E5-9-2M 8-5' FRevi