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APPLICATION FOR SANITATION PERMIT Permit No. 4Qlkl... r (Complete in Duplicate) Date Issued _�-�s--- Application I 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. _!�—o oS' F - "r C.Gri/_ / y4 v E. JOB ADDRESS AND LOCATION-----_-Rt_� 2.....Box_ 958 i -----••--------------------------•-----------•---------------------------------------- .>�. Owner's Name---•--------fix'-•---Faa�'._�`_�,_��._IxCi��i ------ -----•• - -•-------- - ---- ,� ------ ------------------------------------------- Phone-----4:7A4g$ Address----D0t,1xi-lLor_ads-_.1an_e----o---HlokerY...L%rxe.. turn.__N-•--- -.�gu_ e.---11---W''------------•--------•-------- Contractor's Name-.------ Delta-,__ Inc._------- --- -------- Phone......__ � �� Installation will serve: Residence © Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I_ Number of bedrooms ---3__ Number of baths 2---- Lot size ---------------2___$-�1'��-_--__---- __- Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table __40 ft. �f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [ O TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �t Septic Tank: Distance from nearest well________________Distance from foundation_----____-_____----.Material_._-____-_----_-----__--.-_ _ [ ex i in -----------� Ing No. of compartments Size Liquid deptly ----Capacity-- -------------------- isposal Field: Distance from nearest well------------ Distance from foundation--------------------Distance to nearest'lot line_____-_______._-_ ex i gj Ing Number of lines-----------------------------------Length of each line------------------_- • ---------.Width of trench---------------------- Type of filter material------------------- ----.-Depth of filter material-----------------------Total length---------------•------------------------ •- Seepage Pit: Distance fo nearest well-------7S-T-------Distance from foundation___...---.0_'___.Distance to nearest lot line-__--_____5-r.- 11C Number of pits-------)L------------Lining material---br i-Chi_....-Size: Diameter-------- Deptn----- -->'Q .r - --- ....--------- - Cesspool: Distance from nearest well _Distance from foundation--------------------Lining material__---------- - ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------- ------ ------------------gals. Privy: Distance from nearest well________________________________ ----- Distance from nearesr building ❑ Distance to nearest lot line_______________________ --------------------- Remodeling and/or repairing (describe):---------V_ert.___3r_a_1.31_______________________ -------------•-----------------------------------------------•---------•----------------------•---------•-•--------------------------------------------- --------- ------------------------------------ in County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------------------------DeIta-4----Inc-•--------------------------- ------------{Owner and/or Contractor) Title By---------------•------ Perry QR �far#�ha x ? o 2 Gen.M r. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____________ ----- REVIEWED $Y_ ------------�-- X DATE_ BUILDING PERMIT ISSUED-------------------------- DATE -------------------------------------- #erations and/or recommendations:_-_-------------- --- - -•----------------------------•--•--- -- - --------------- - ------ ---------------------------------- ----------------------- FINAL INSPECTION BY________________________ ------- - --- Date--------- SAN ----- --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 ES-9-2M I0-52 Revised W-2100