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r � � vrd4C UJC: (� <br />I-- -- : <br />---------------------------------. PLICATION FOR SANITATION PERMIT Permit No....._..__ <br />----------------------- t l 1..._.. <br />------------------ (Complete in Duplicate) <br />----------- --• This Permit Ell <br />XlDires 1 Year From Date Issuedf �y <br />Date Issued <br />Application is herebymade to the San Joaquin Local Health "Dist rict 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 --- --------------------x.622- Stanford <br />------------------------------------•----••--------•-------_. -. -----• .................... <br />Owner's Name-----------------•-•---��•- .-E,_ �nnee � <br />------- ------ -- :�. 24.03 <br />-- ----. Phone.--• -----•-•-•••. ------- <br />Addrens_--•--------------------• AbOVe -- <br />Delta S tic Tank Serviced Inc. <br />---------- <br />Contractor's Name_----••------•-•-------------•-�?--...--------•----- ----- -•- 3 �26g <br />--------------------- Phone.. Ho. ........................ <br />Installation will serve: Residence (�C Apartment House ❑ Commercial <br />Number of livingits: 1 _-- 2 F-1 Trailer Court [:] Motel ❑ Other ❑ <br />unNumber of bedrooms .------- Number of baths_---- Lot size __..--.-_x-_I 0 <br /># t <br />Water Supply: Public system ' �"- "'-' � `-----•• <br />Y [� Communi+y system ❑ Private ❑ Depth to Water Table <br />Character of soil to a depth of 3 feet: ' Sand ❑ Gravel [j Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br />Previous Application Made: (If yes,date--------------------) No <br />t [�: New Construction: Yes fnNo ❑ FHA/VA: Yes [3No � <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septic Tank: Distance from nearest well ----- ------------ Distance from foundation---_._ <br />- ------------- Material <br />X ting No. of compartments --------- -................. Size -------------------------------- Liquid depth ---•------------- ---•---- Capacity <br />Disposal Field: Distance from nearest well ------------------ Distance from foundation -------------------- Distance to nearest loline --___-_--.-.__... <br />Ex$hting Number of lines ----------------------------------- Length of each line------- _----------------Width of french.__-_-__-..._..-•--••-_ \ <br />tv •" 3- !`f-10' Type of filter material.. - _ .__.. <br />t -- -------Depth of filter material, ------------------_--Total length -------------------_---- <br />Seepage <br />4: Distance to near t well---i1�0I1E-------Distance from foundation- _19-t 5ti <br />-�'/ _._._Distance to nearest lot line----------------- <br />40 Number o pak-.... -___�,---------- Lining material ---._rA-ek ------ Size: Diametef4, . j <br />Cesspool. �EHa�N S Depth_.Xs_-..ia. <br />P Distance from nearest well - ---------------- Distance from foundation---_-_------.__ <br />i Lining material.-- <br />Size: Diameter,----------•-------------------•---..Depth----------------------------------- ----•---••---••--- <br />•---------Liquid Capacity -gals. <br />Priv-------•----•----•--...---• <br />❑Y� Distance from nearest well--------- --------------------- --------------------- Distance from nearest buildin <br />Distance to nearest lot line-------------------- building ----------------------------------------- <br />-------------------------------------------------------------------------- -------------------------•--------••-------•---------------•-••-------•-------•••----•-----•------•-------------- <br />Remodeling and/or repairing <br />g -----------------Adding.--Fi,1t.>�x�beci,...�o._.����.'��x�g-- ®Y®tea <br />- - ------------------------ •------------ -- r <br />4 -------te---- <br />----------•-----------------------------------------------------------------------------------••--------•-------- ------ ----- --- <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br />(Signed) ----------- --Del•ta._.5_ap_t±w._.. aTlk -3erp1 ■ <br />t -------------------------------------- -------•----- ------.(Owner and/or Contractor) <br />BY:--•- •••• ........................Per Warthan <br />�'------------------- ------------------------------------------ •---------------- (Title) ----------- Q!m Mgr, <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br />r <br />FOR EPARTME T USE ONLY <br />APPLICATION ACCEPTED B ----- r <br />REVIEWED BY 1,.- -•-----•--------- DATE -------- o2-`--..��. <br />--------------•- ----- DATE-_--•-•------•---•- <br />BUlLDING PERMIT ISSUED-_.. -----------------------------•--------- <br />- ------------•----------•- <br />AFteratians and/or recommendations -------------- ----------------------------------------------------- <br />,1_ ATE <br />- tri ---�- <br />%..--/ .-- z-................................ ----------------•------ ------- •------ <br />--------------------- <br />....- <br />----------------- ---- <br />--------•----------•----------------------•------•------ <br />----•--------•---------•--._...---•--------- <br />FINAL INSPECTION BY:. -:- - <br />-- - -- - - -------------- <br />----•------- ----•• - Date. -C T`:_..��-----��-----------------------..--...-.-- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Srreet <br />124 Sycamore Street 105 West 9th Street <br />Stockton, California Lodir California <br />Manteca, California Tracy, California <br />E6 9 REVISED g•gg 2M 6-61 ATLAS <br />