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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 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. JOB ADDRESS AND LOCATION-------------------21a__S_x Sin+wlax'--------------------------------------------------------------------------_-_-.__------------------- Owner's Name_...------ D' ------------------------------------------------------------------------------------------------------ Phone-no----------------------------- Address--------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ Contractor's Name----------Delta------------------------------- ---------------------------------------------------------I---------------------------- Phone-----'3-39-�a--5------------- Installation will serve: Residencef] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of-living units: M Number of bedrooms ® Number of baths ]. Lot size_ ___________________________________________ r Water Supply: Public system ® Community system ❑ Private'❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[a Hardpan ❑ 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___________________________________-________:___. exUt ing No. of compartments--------------------------Capacity--------------------- .Liquid depth--------------------- --Size------------------------------ ----- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-__---_______---__-_________-______- ] ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------,----------------_-____________- ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well---------------------Distance from foundation-------------------Distance to nearest lot,.line__-__� ---_ �] Number of pits___l:`_i-------------Lining material____br jv,k----Size: Diameter_____ h____-°' ___-------..---- Disposal Field: Distance from nearest well__________________Distance from foundation_________ ,- ----Distance to nearest 16t'line_________________ ° eX�qt frig Number of lines-----------L--------------------Length of each line------------ _____.Width of french_________________-__--_--_________ Type of-filter material--------------------------Depth of filter material_____________________._ Remodeling and/or repairing (describe):----_-d-=tz---ver--t c-ar1---drain--oma-1,y--- an_e-nd---of--gym- -t- ,ns---------------------- le-ac-h__-(fix-ain--------------------------•--------- 1 ---------------------------------- ---------------------------------------------------------------------------------------------------- ---------- ------------------------ ---------------------------------- ------------- --------------------------------- -------------1�------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. (Signed) -3e_lta__Septtc.---Tax1k---Se-r.-v--------- --- -----------'7)---- ----------------------------------- (Owner and/or Contractor) By:_,._ _1A9 x!_han--------------- (Title) 4 4x'—�s gr.------------------------------ k Plot tans, showing size of lot, lavation of system in relation o s, buildings, etc., must be filed with this application). tl [ P 9 Y 9 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y 4zj :- DATE- — --------------------------- r --- 2. REVIEWEDBY--------------------------------------------- -- ----- ----- DA---------------------/--- -- ------------------- BUILDING E-----e---------------------------------------- BUIL.DING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------------------------- ------------------- ------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------- ---------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------- p --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- i PERMIT Not_�1_6Z_.---- ISSUED----- ----------(Date) FINAL INSPECTION BY:---.-L4)-.v--- ---------__ >. x Date. k SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50-W=1639