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APPLICATION '.FOR SANITATION PERMIT Permit No. ----- (Complete in Duplicate) S 9 S pate Issued ________^-..�____�— VV Ap station is hereby made #o 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. ,JOB ADDRESS AND LOCATION 17�� ` G�1Chx'��-------------------•_.---------------------------------------------------------------- .--.---------- Owner's Name--••----------I...---D,rr3-.kp-er---Small--------------------------------------------------------------------------------------------- Phone3"'1.56-7------------------- Address----------------- -----•-------•---- Address----------------- •-••" e----------------------------------------------------------------------------------- --------------------------•------------------------------------------------------•---- �I: Contractor's Name-----------Dalta------------------------------------------------------------------------------------------------•-------------------- Phone--- -_309_5_5_...----------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I� Number of living units: _l___ Number of bedrooms _2____ Number of baths _1--_ Lot size ___________________________-.._-____.__-_ Water Supply: Public system F&] Community system ❑ Private ❑ Depth to Water Table ______ ft. Character of soil to a depth iof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[g Hardpan ❑ i Previous Application:Made: pYes ❑ No [�: New Construction: Yes ❑ No-® TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance 1 ram nearest well_________________Distance from foundation--------------------Material _______________-._____-_--________ ----------- EXIUI.NG No. of compartments--------------------- ----Size--------------------------------Liquid depth--------------------------Capacity-------- --------- i Disposal Field: Distance ,from nearest well-________________Distance from foundation--------------------Distance to nearest lot line___________ �I E.�,QNEU.G Number of lines-----------------------------------Length of each line-_-----------------------__--.Width of trench--------------_-------- ---_-----Depth of filter material-----------------------Total length--------__----------------- --_----- Type of filter material________________ p Seepage Pit: Distance to nearest well- i0_.'E______._Distance from foundation-____-----------Distance to nearest lot line__ p' Number of pits--------Z----------_Lining material----b?^_1,� -----Size: Diameter-----3................Depths �------------.----------- e Cesspool: Distance from nearest well-----------------Distance from foundation ___.__._______.Lining material___________._______ _ ------------- El Size: Diameter Depth Liquid Capacity ± gals,. 1 Privy: Distance-from nearest well________________________________________________Distance from nearest building------------------------------------------- ElD'sstance'Ito nearest lot line---------------------------------------------------------------------- ------------------------------------------------------------------- Remodeling and/or repairing {describe :_-__Vert_lC_c .--- ri d.___C_4...%1Z�C?Ctr_ iA --- --_ - k'v-.t ---�73th............... a --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ________________________------------------------_____--------------------------------------------------------------------------------------------------.------------------------------------------.-_..-._____________________ I 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. I De ---------------------------------------------------------------------------------------------------------------------------(Owner and/or Contractor) (Signed)----- •---• ------------ ---- �err �I (Title}__Owner-=lir By:---------------• •-- -Y-N'��arthan --- - - - ------------- - ------ - (Plot plan, showing size of to#r location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I' III �� APPLICATION ACCEPTED BY -------------------- DATE ------------------------------------------------- REVIEWEDBY------------------------N---- :---------------------------------------------- -------------------------- --•-- DATE S BUILDINGPERMIT ISSUED)------------ -- ------------------------ ----------------------------------------------------- DATE-----------•--e------------------------------------------- 11 Alterationsand/or recommendations------------------------------------------------------------------------------------ ---------•--------------------------------- •--------------•-----•-- -------•----------------------------------- -"---------------------------------------------- ---------------------------------------------------------------- . -------------•-------------------------------------- ----------------------- IM IN ----------------------- I� --------------------------------------- ---------- -----------------------------------------------•--------------------------------------------------------- FINAL INSPECTION BY:L ---•-=----------------- - Date 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 E I ES---9-2M€ 8.51 Revised W-2100 ! ,