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Permit No. APPLICATION FOR SANITATION PERMIT r 34 1P, M (Complete in Duplicate) Date issued __'��!�._..G This Permit Expires 1 Year From Date Issued! Application ii,46bl-ade-tcrthe San Joaquin Local Health District for a permit to construct and install the work herein described. This a"ppli�ation is mad in compliance with County Ordinance No. 549. 848 Weet- Howard JOB ADDRESS AND LOCATION__________________._______--.--------- . ' Ha.Phone_ E_ �Joe ad_ Ras7 _J_h-d -- ---------------- ------------or's Name-- ••--- - n : ---------------- -------- ---------'-------------------• --------------._--------ar ddess------------ ------ ---------- -------------T - ------------- -be ; --69----- -Delta Se tic Tank derv. Inca Phone_Hog _ _1.2 actors Name-------------------------- A ----- c--------------:------------------- ; `�"Contr 4t Installation will serve: Residence.&] Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofie! ❑ Other ❑ NumbeA6 o! living units: __1__ Number of bedrooms __2--- Number of baths __-!_- Lot'size ------6a--- ---1_2-?-------------------------------- Water Stpply: Public system [2 Community system ❑ Private El Depth to Water Table _ ____ ft. `. Characi''er of soil'to a depth of 3 feet: Sand;❑ Gravel ❑t,Sandy Loam [IClay Loam❑ Clay ❑ Adobe®Hardpan ❑ Pal s Application Made: Yes r No ® ew`Constr`uction"�Yes�[]— NoX] FHANA: Yes E] No I M �TYPEOF INST*LL' I00'AND SPECIFICATIONS: l { i tank or_cesspool permiffed_if public sewer-is available within,200,.feet.)__L_ _.. ,._•. _ �—iw •- W, f No se is _.- -. �l I + Septic Tank: Diss`tance from nearest well_________________Distance from foundation--------------------Material__-__..__-_----_______--.__.____-- ________- Exerting 1 No. of compartments------- ---- ----- ----Size------------------ -------------Liquid de th----------------- ---- - -Capacity-------------------- - Disposal Field: Distance from nearest welI.I1Q__.-------Distance from foundation-----1.01-------Distance to nearest lot line---5________._ �. `. 11 �e of filter material____._I'4Ck__---_Depth of filter materia___ _3.8"�----.Total length______3_Q_._e_ Number of lines--------------1-------------------Length of each line____-- Q--- - -----------.Width of trench._____., ------------------------- G -9 r r 1 �y,G-, TY Seepag 'Pit: DisJlJtance to nearest well_____AQ_.-____`.Distance from foundation____ , ---------Distance to nearest to line__ ______._.._ �{ [, Number of pits-----.1--------------Lining mater�ial_.T'OCk----------Size: Diameter---33°------------ .Depth_�5__-.__IDa]t,a---__-_-- tiI Cesspool: i( Distance from nearest well-----------------Distai,ce from foundation--------------------Lining matenl--------------------------------- ___ _ f ❑ I Sil Diameter--------------------------------------Depth-=;-..-`--------------- --------------------------- Liquid Capacity gal 1 Privy: ; DA$t�ance from nearest well------------------------------ -=------ ---------Distance from nearest building----- - _------------- .......... s C �. ❑ } Di!ante to nearest.lot line. ---------------------------------------------------------------- Remodeling and/or re�airing (describe)---------------cidd�flg--.F''f� '�E%'Y �-�d---Ga---ex�8t�ng---ByS�em_-b�---D_ -------- fiJ 1A e , ---- --------------- I --------- -- I l hereby certify t a h`have preps d 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) P.eI a -�E _ C 11k. '�GI"V,� IT1C�---------------- --------------------------------------------------------(Owner and/or ConfT actor) By: Perry -------- Gen Mgr.----------------------- y------ - -��-�----Warthan------------------- ---------------- - ------------------ -------- - (rtlel---------- -�----- - (Plot plan, showing sizeeof lot, location of system in relation to wells, buildings, etc., can be placed on reverse side).�T �► FOR DEPARTMENT USE ONLY APPLICATIONAC}E}jjD BY-------- --- ----------- ---- ------------ ---------------------------------------------- DATE------- ' 'J fP l ------------------- REVIEWED SY - DATE------------------------------------------------------------ BUILDIPJG -�--�v-�Q ---P-�E;R-1M-`--ITy-t_-.--I9�k5AUED---------------------------------------------------------------/-----------------------------------=-- DATE--------r- -------:-----------------�---_-- ----A--�----z-�----_-�--.------- Aerae -- -----s an - ----- - ' / -------------•---------r � ------------------ -------------------------- 1 / -':� -e; ]'— FINAL INSPECTION BY:_..-- ----- -- ---------------- -Date------1- __-�------ C 2 W__� �---- 6 -------------- 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 Revised 8-'59 F.P.CD.