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1 II APPLICATION FOR SANITATION PERMIT 4f � � I i (Complete in Duplicate) I Application is!Ihereby 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, JOB ADDRESS AND LOCATION------------6-45---fid......Gertrude -------------------------------------- -------------- ! -------------------------------------- Owner's Name______-___Fr-ed.---E_:__� - -118 .111--------------------------------------------------------- - ----- -------- Phone---q-998------------------ Address----------- - - --------- Address----------- 6-45-=- '----Gart-bUda - -------------------------------------------------------------------------- -Contractor's Name- --------Delta-------------------------------------------------------------------------------------------------------------------- Phone----3 3955-------------- .Installation will, serve: Residence [N Apartment House ❑ Commercial ❑ Trailer--Court ❑ Motel ❑ Other ❑ Number' of living units: U Number of bedrooms 11 Number of baths El Lot size__:___ Wafer Supply's Public system ❑ Community system ❑ Private [ 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IN Hardpan ❑ # II TYPE OF INSTALLATION AND SPECIFICATIONS: '�kl} (No sepfic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: ;' Distance from nearest well-------5Qr---Distance from foundation--------101------ Material_'L ;� No. of compartments-------2----------------Capacity------SOC}--------Size__-e--J1?-t-4e---------Lcquid depth-------41---------------- Cesspool: �I Distance from nearest well-----------------Distance from foundation-------------------.Lining material__________________________________ ! ❑ Size: Diameter------------------------------------ Depth--- --------------------------- ------------------- Privy: -----------------Privy: Distance from nearest well_______ _______________________________ _______Distance from nearest building---------------------------________.___ II ❑ ;I Distance to nearest lot Gne_______________________________________________ Seepage Pit: '1 Distance to nearest well-----------------------Distance from foundation------------------- Distance to nearest lot line______..__--_-_-_ EXT,STL7;NG I Number of pits----------------------Lining material--------------------- -Size: Diameter------------------------Depth--------------------------------- Disposal -------------------------------Disposal Field: Distance from nearest well------------------Distance from foundation------------------- Distance to nearest lot line-_________._____ EXISTi�G Number of lines-----------------------------------Length of each line------------------------------Width of trench--------- ------------------------- iType of filter material________________________Depth of filter material_____-__._.__-_______-_ Remodeling and/or repairing (describe):--------Ins tallin _-- -------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- ----------------------- I hereby cerfify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stdfe laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----DDelt-a-------------------------------- ------------- --------------------- --------(Owner a-nd/or Contractor) I .; -- - - By:-------I-------Fang---Wart ars- t �,j ¢-------------- ---------------------- -- -----------------(Title)-----Owner-=.0 Sn.------------------------------ (Plot plans, showing size of lot, location of system in relation to wells, buildings, efc., must be filed with this application). j� FOR DEPARTMENT USE ONLY APPLICATIONjilj ACCEPTED BY DATE REVIEWED BYII DATE ----- -- ---- ------ ------- BUILDING PERMIT ISSUED ----- ------------------------------ -- DATE Alterations a4or recommendat ions:------------------------------------------------------- --------------- --------- -- --- --- ---- --------------- 11151111�19 -------------------------- 1 ----------------------------------------- ----- - ---- PERMIT ---------(Date) FINAL INSP No.- I - 5L t b ._____- _-- ISSUED---------- ---�- - --. '-kECTION BY:------- -- ---------- --------------------------------------- Date-------------------- ----------°� q _ SAN JOAQUIN LOCAL HEALTH DISTRICT a" 130 South American Street ! Stockton, California E5-9-2M 9-50 W-1639