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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------3_ 1---A Ade-lbert--------- --------------------------•----------------------- --------= ............................-� <br /> Owner's Name----------Ra-y--- --------------------------------- ----- ----------------------------------------------- Phone_.3-469------- r <br /> -- <br /> Address----------------------- 2.8Q...a•---'�'I,tt.:tem----------------------------------------------------------_-_---------------------------------------------------------------------•---. --- <br /> '. <br /> Contractor's Name---Dalta...Septih---Tank-G-Q-•-r-------------------------------------------------------------•------------ Phone.3.ag-55---_----_---- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Ej cabins <br /> Number of living units: JZ] Number of bedrooms ❑ Number of baths ❑' Lot size----OQ!X31Z_1.........................-------- <br /> Water Supply: Public system ❑ Community systm ❑ Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Gavel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobef] Hardpan Q <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewl is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation------------- --_.Material----------------------------------_------------- <br /> El <br /> _ ----_.❑ No. of compartments---_----•---------------Capacity......................Size................................Liquid depth_------------ ------ <br /> Cesspool: Distance from nearest well.................Distance from foundation..------------------Lining material--..........-___._.__..._:_..__._..... <br /> ❑ Size: Diameter--------------------------------------Depth---- --------------------------- -------------- <br /> Privy: Distance from nearest well.................................................Distance from nearest building------------------------------------------ <br /> El <br /> ____ ____-_-•_ ---_------._-_--___-- <br /> ❑ Distance to nearest lot line___-_-_____-•-________-•-----------------•--•__- <br /> n <br /> Seepage Pit: Distance to nearest well-----jj65 ------Distance from foundation....................Distance to nearest lot line---2.5!.-__.-. <br /> Number of pits......I-------------Lining material..__rAck------Size: Diameter•••.----:------_ _..Depth----_-----------------­- <br /> Disposal <br /> -___;-_ -•-.-_.__Disposal Field: Distance from nearest well__._15,0.t._.Distance from foundation--------------------Distance to nearest line.•--: -.,. <br /> Ga Number of lines........1---•--_-_-------------Length of each line....._.._50-x__'..........Width of trench..2_! ---—----------------. <br /> Type of filter material...38ki &__Depth of filter material•_________________ <br /> ,ft 'd <br /> Remodeling and/or repairing (describ ------- ta,2.7.st.J on---of---ox18....(.1 -.-.50_w....Of---har- Z.Ont,al--_le-Lch <br /> brai w1U7*--4ne--- 1) +1 �rart .....wit1j.-fifex--rack._ellr-ille-d•-dnw.n--,to...sand, <br /> ar tca• 49&tis-festprg-• a—--a orl ta_the---Loaal--Health..Departmant.*------ _..- <br /> ------------------------------------------------------------------------------------------------------------------ <br /> I <br /> hereby certify that" <br /> have prepared this application and that the work will be done in accordance with San Joaquin Coun!llo <br /> ordinances, State laws, and rules and regulations of the San.Joaquin Local Health District. <br /> (Signed)---De-l-t-a---S8p51c••-`I'ank•••Ser-uice...------B --_Ferrer--Warth=-•------------------------(Owner and/or�cetragt <br /> g • (rifle). Owl er nUr- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> t" <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY....... :-,.. ................................................................ DATE--------$.=- 3�--- <br /> REVIEWEDBY.............................------ ------ ---------------------- --------- DATE `'F �......................... <br /> BUILDING PERMIT ISSUED - --- - ----------- ------- DATE--------- J�frJ � - <br /> Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------- ---=---•------•--------------------------•- ------------------------------------------•---------------------------------------------------------- <br /> ................................--------------------------------------------------------------------------•------------•------------------------------------------------�•.. --- ------------ ------ <br /> -------------------•-----------•----------------------------------------------------------•-----------------.--.............................................. ---. . .... ..................... <br /> PERMIT No._....a-1----------- ISSUED.........j_ l .----(Date) FINAL INSPECTION BY:...... ...... ............ . <br /> Date----- --------- --- f' .... .- ................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton,California r <br /> }-9-7M 9-50 W=1639 <br />