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r rmit No. APPLICATION FOR SANITATION PERMIT Pe .- -.1... ....... 3 (Complete in Duplicate) p Date Issued. r �} "Apel cation 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. JOB ADDRESS AND LOCATION----------5-G5...S- UaId-an---Ga-tp----------------------------------------------------------------------------------------------------- Owner's Name--------------------Ambnaaa.-F1Qrjeja------------------------------------------- -------------------------------------------- Phone-Z-71�Q----------------- Address--------------------------------22.MP------------------------------------------ -----------------------------------------------------------------------------------------------•--------•--•------------ iContractors Name-----------_----------Deltaas-..I Q-...----------•--------------------- ------------------------------------------------Phone----��-��9 ------------ Installation will serve: Residence [I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I--- Number of bedrooms __2--- Number of baths 1-..-. Lot size -----50x150 ----------------------- Water Water Supply: Public system [2 Community system ❑ Private ❑ Depth to Water rTable .Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No [N New Construction: Yes:E] No ❑ w TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well _-_-T1s'-.---Distance from foundation--_90Mcement-brick k 3�� x4 & $d� No. of compartments ----Size---- --- -_ --------L� uid de .th-- --- -----------_Ca acitY� j, i Disposal f=ield: Distance from nearest well.-----------------Distance from foundation--------------------Distance to nearest lot line_-_.-_--_----.---G ❑ Number of lines-----------------------------------Length of each line--------------------------.-.Width of trench----------------------.------------ Type of filter material--------------------------Depth of filter material--------------.--------Total length-----....-.---.-.---------------'----.-.- Seepage Pit: Distance to nearest well----no-------------Distance from foundation.aMP-1.e-Distance to nearest lot line----5---------. t] Number of pits-------J-------------Lining material--b-r-iak------Size: Diameter----36--------------Depth-----�5--------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-----------.---.---.----.--.--.------. Size: Diameter--------------------------------- - -------Li ui ❑ Depth-----------------------•---------------- - Liquid Capacity----------------------------gals. " Privy❑•. Distance from nearest well-,-.---_----------------------------------------Distance from nearest building----.------------_------------------------ Distanceto nearest lot line------------------------------------------------ ---------------------------------------------------------------------------------------- Remodeling and/or repairing (describe) T1eW----S S-toM----------------------------------------••---------•-•------- --------------- -------------------- --------- ► ---------------------------•-------•--- ------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------ I ------------------------------------- ---------•---------------------------------------------------------------•---------------------------------------------------------------------------------------------- -------------- 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. € (Signed)................Dalta InC• - ---------------------{Owner and/or Contractor( B . P•-- (Title)-------Gen. Mgr. Y' _ --------------- (Plot - ----- r-- ------------------------"--- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F ARTMENT USE ONLY APPLICATION ACCEPTED BY - ----- --- I---------------------- ------• DATE )/ --->--_------------ IREVIEWED BY----------------------------------------------------------------------------------------------------------------------------- DATE-------------------- ----------------------------------- IBUILDING PERMIT ISSUED-----------------------------------------------------------------------------------------•- -------- DATE---------------------- �. . Alterations and/or recommendations:--------------------------------------------- - ---------------------•----•------------------------- -------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------•--------••----------------------------------------- -------------•------------------------------• --------------------------------------..---------•----------..-..---------------- i -------------------••-------------------------•--I-----•-------------------------------•----------------------------------------.------------•------•--------------------------------------- --------------------------------- -----------------------------*----------------------------- ------------•----------------------•-------------------------•----------------------------- --------- ------------"---- ----------------------•---------------------------------- ------------------------------------------------------------------------- l r FINAL INSPECTION BY: f' iDate-. --- _ `' SAN JOAQUIN LOCAL HEALTH DISTRICT l � ' / 110 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street I 1"',,Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100