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p APPLICATION FOR SANITATION PERMIT a (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. W. 6th -------------------- JOB ADDRESS AND LOCATION-------------------3�� - --------._ -------- ----------------- ----------------------------------------------- Owner's Name...---F0qq--4!X!4Aa9!8----------------------------- ------ Phone------------------------------------ Address------------ -35 W. 6t$ -------------------•------------------------------------------------------------------- Delta Phone__3--RAi --------------- Contractor's Name---------------------------------------------•------------------------------------------------------- Installation will serve: Residence ;K] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -[I Number of bedrooms [4 Number of baths 91 Lot size--------30X100--------------------------------- Water Supply: Public system U Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [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-------- from foundation_____�!_.--_.___.Material �edW00-d 9] No. of compartments--------2---------------Ca aci 800----------Size__. x3 ___...•-------Liquid depth__''______--_-------------------- 91 --------- Cesspool: Distance from nearest well_______________ Distance from foundation--------------------Lining material____________-_-______-_____________ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- --------------------------------Distance from nearest building------------------------------------------ Privy: Distance from nearest well---------------- ❑ Distance to nearest lot line------------------------------------------------ See a e Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- EXI'ING Number of pits---------------------Lining material-----------------------Size: Diameter------------------------Depth---•----------------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line___._____________ k4LSTING Number of lines-----------------------------------Length of each line------------------------------Width of trench--------------- -------------------- I Type ----------------- Type of filter material-------------------------Depth of filter material______________________ n Remodeling and/or repairing (describe):------Installing--- ng gptic tank --lar -er eea --------- ------- ---------------------------------------------------------------------------------------------------------------------------------------------•---------------------------•------- 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. _ X011a--------------------------------�----------------- ----------------------------------------------------------------------(Owner and/or Contractor) (Signed)--------------------------- - Owner-�gr. �D_.�--------------------------------------------------------------- ------ -- ---------- ------------------------------------- Title-------- ------------------ ------------------------------- By: Perry Warthan-------------------------------------- (Title) (Plot.plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY �J DATE ` —� ------------------ --- - - -----------�-------------------------------------------------------------- DATE-----------,-----�--'�-If -=-------------- APPLICATION ACCEPTED REVIEWEDBY------------------- ---=------------- -- --- BUILDINGPERMIT ISSUED------------------------------ ---------------------------------------------------------------------- DATE-------------------------------------------------------------- Alterations and/or recommendations------------------ -------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- ---------------- ----------------------------------- - ---------- --------- ---- Y Date FINAL INSPECTION 13Y--------- -- -- - --------------- PERMIT No LP_-----•__-- ISSUED----s------- ---- ------I bate--------------5.--- -- -----� -- •�--------•----•----------------•-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9---2M 9-50 W=1639