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APPLICATION FOR SANITATION PERMIT Permit No.11__C1._7_. (Complete in Duplicate) 1-3 C Date Issued ---- ._- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he d cril�ed. This application is made in compliance with County Ordinance No. 549. ,E JOB AD DRESS AND LOCATIQL----------------Rt- 3-5----Boa---243-,---.a0_rne_r_.--of---SA r lir-.-Lance..-&--I�Qr��r_---Sac. Rd Lo � Owner's Name--T-.-Ta-�1Lt->"�----------------------- -------'----------�.i., C2,J.1f. SIE sorrier 9-2082 -------------------------- ---- ------------------------------------ -- Phone----•------••----------------------- 1 ----------------------------------- Contractor's Name---------Delta . ____ --•- ------------•-------------------------------------------------------------- •-•--- Phone------ ----395�.---------- Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. -2---1. Number of bedrooms ____4_ Number of baths .-I--- Lot size ---_�.04z[13�--_______ _ Y �.: ------------- i Water Supply: Public system ❑' Communify system ❑ Private ® Depth to Water Table .30-- ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No:U New Construction: Yes ® No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest welt_-_---_--------"Disfance-from'foundation-:._----- .--__-.M terial°� -: -•--------------- t?X St lng No. of compartments--------------------------Size----------- ------ ---------------------Liquid depth-------------------------Capacity-------------- -------- Disposal Field: Distance from nearest well----------------Distance from foundation-----------------.-.Distance to nearest lot line----------------- I exLrig Number of lines----------------------------__----Length of each line------------------------------Width of french----------------- Type of filter material---------------- -----Depth of filter material-----------------------Total length-------------------- ------ Seepage Pit: Distance to nearest well___-----75-1 ------ from foundation_--1Q-'-..-----.Distance to,nearest lot line------ ❑X Number of pits-----I---------------Lining material-br.1-C1i-"-------Size: Diameter-- t -4- --------..Depth-------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------_.--._-_- ❑ Size: Diameter- ;n x Depth__ : a --_ -- Liquid.-Capaci.tY gals {ti h Privy: Distance from nearest well-------------------------------------------------Distance from nearest building1411 Distance to nearest lot line___---___- 1 } Remodeling and/or repairing (describe)--------------v-ert-.---------------------------------- -----------------------------------------------•--------------••-------------------•---- f ----••------•------------------••----- -------------------------- - ----•------ i F --------------•--------------------- ---- ----•------------------•---------------•-------•-----------------------------------------------------•------------------------------------------------------------------"-- ------ I herebycertify that I have Y prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. (Signed)-------------------------------- Delia, ItZc! ---------- ----------------------------- ----- ------------- -- ------------------(Owne .. By:---_-----------•---------------=- P:.©-*-�-. (Owner and/or Contractor) --- ------------ - - - --- ------- -- {Title) _ _G�n� � t.- _ k> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f; FOR DEPARTMENT USF '0E ONLY Af APPLICATION ACCEPTED BY..._......- ---- Ip 71g� -- �_ f ------- ---------- DATE-------(- ---------------------------------------- '•� - VIEWED BY-------------------------- -- ---------------- - ------- ------------------------------ ---- -------------- --- ---- - DATE------------------ ------- BUILDING PERMIT ISSUED-------------�..-------------•- --------- ----------------- Y -----------•-------------•------------ -- -----t=------------------- DATE------------------- Alterations and/or recommendations------------- ------ ----------------------•---------- f` � i ------------------------------------- % 1 ---------- ------------•- ----------------------------------------------------------------- -------------------------------- ---------------------------------- ------------ ------------- FINAL INSPECTION B -- - ----- -- ----- Date----------- 1 --' ----- ------------ ------------------------------------ d ` 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-9-2M 10-52 Revised W-2100