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FOR OFFICE USF y � -Z-rte------ APPLICATION F SANITATION PERMIT Permit NQ. ...�.. G +. = == -- {Complete in Duplicate) -------------------------------------- This Permit Expires 1 Year From Date Issued Date 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. I'd "4 ;'.sem)] JOB ADDRESS AND LOCATION 3 '2�-.Volnep---•-----------------------------------------'F��--------•-•----••-------..----•--.....-- ............ Owner's Name------------- LeG, a,nd .Carolina DulaY. --------------------- --------------------�- 1----------- Phone•H�•----� -X191. -- -------------•----------•---------------- Address----------- 3352 Phelps ` 3. - -••o 3---- -- Contractor's Name-------Delta Se -----------------------------------------------------tic Tank Serrvieem --------------------------------------------nc. Ho. �12�9 $•------ Phone Installation will serve: Residence;E] Apartment House Commercial Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--- Number of bedrooms _.2--. Number of baths .---;-- Ldt'size -----5 1-54 --------------•----------- Water Supply: Public system [ Community system ElPrivate Depth to Water.Table'!-31 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay'Loam ❑ IClNy [j Adobe-E] _Hardpan El Previous Application Made: (If yes,date--------------------) No [3 New Construction: Yes C] No ❑ , FHA/VA: Yes [j ' No F] INSTALLATION AND SPECIFICATIONS: 11�- �, TYPE OF INS (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--_-none Dist ice from ou dation----- -Q=---_-.Ma, i I„_�_Cemi nt-tbrick �C] No. of compartments------------------------ oil -Size Xb-. -_�X�- -Li Liquid de th--.---- ---'--.--Ca Capacity SCC g q 10 e. P tY 5? A,; Disposal Field: Distance from nearest well_none Distance from foundatiq_n------------=------Distance to neares#-lit line----------------- X] Number of lines-------------- -------------------Length of each line----------51t--- :?:Width of trench; *---_---------------.--------- Type of filter material---rocY----------Depth of filter material_----1------------ -Total length_----. ----,-----:---- --_ I Seepage Pit: Distance to nearest well__-none - __Distance #rom foundation--1 D.-.--_--•_-.Dist nce to nearest lot line--- ---------- Number of pits------�--------------Lining material--r94--_ 331 251 MM. Size: Diameter Depth - ------------------------ Cesspool: Distance from nearest well----------------- from foundation--------------T_-.Lining material----------------_--------------_--1- ❑ Size: Diameter-------------------------- ----------Depth--------------------- ----------------------------Liquid Capacity-------------------• ------gals. (.. Privy: Distance from nearest well--------------------------_----------------.----Distance from nearest,building---------------_-------------------------. ❑ Distance to nearest lot line------ ----•----------------------------------------------------------- ------------=•------------•--•-----•---------------------------------- `1 '.1 r �,r.-.s 4�17 Remodeling and/or repairing (describe):------------------------ nat*IUAg--nPW_--sy8 a ----------------------------.--__•----------------,••-------- ---------------------------------------------------------------------•----------------------------------•--------------------------------------------------------;-------• --------•--------------------------------------- �. ------------- ----------------------------------•----------•-•---------••------•-----•--------------------------------------•--•----------•----------•--------------•------•--•----•--------------------------•------------ \\ --------------------------------------------- ------------•-----------------------•--•-------------------.... :' ----------------•-•--------- ------------------••-•-------------------•-------------------- 1 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)----------------Del-'UL---- ' ' ---In_C-----------------------------------------------------------(Owner and/or Contractor) Gen, Mgr. By:----------------P rrV---W�.rthf! --------------------------------------------------------------------------•-(Title)---------------------------------------------er (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---J- --f --- --------------•------------------------------- DATE ----- -------- - ------------------ REVIEWED BY--------------------------------------------- ----------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-----------------------------------------------------------------------•----------------------------- DATE------------------------------------------------------------- Alterafions and/or reco endattoo ns:_ = .. ----------------------------------------- ry ,44 '-•- `t_�s�'f'�-��sL�t `- S'..... -/"FLS/lti�a4f_' cFGCf4. .e r ---------- ------ ----------------------------------------- ---------°--• -- it Z FINAL INSPECTION BY: = ---------- - ---- ---------------- Date-------�---- ------------ ................ -----------------------------•-- V s N JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Cal0cirnlo Tracy,California ES-9 REVISCID B-59 F.P.00.2M 6.60