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------ APPLICATION _ _ ON FOR SANITATION PERMIT Permit No/6--'�_...--------- -(Complete ...._. (Complete in Duplicate) Date Issued 10 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. x This application-is made in compliance with County-Ordinance No:..549. JOB ADDRESS AND LOCATION------ 00, E,____Washington St.__,== FF - -------------------------------------------------------------- Owner's Name ---------L1Ay_d___00.VhbA 1--------------------1-------_I_ i 39 t ------------ -------------- ----------------- ------------ Phone- - k y �. Address_-•'_. 1Q0__�� 311T&Sh. = # ..x - ----------------------------------- ------------ --- f Contractor's Name -------------Della d Phone 3-3955 ------- Installation will serve: Residence I2p Apartment House ❑ ,Commercial ❑ Trailer ,Cou t-.[] Motel El Other Nu ber of living units: ..1_c Number of bedrooms 21_ Number,of baths i L°otsizeax10� ------------------------------------------------------------❑ Water Supply: Public system `E4. Community system ❑ Priva-te ❑ Depth to Water Table -------- ft. , Character of soil to a depth of 3 feet: Sand ❑ Gra el ❑ Sandy Loam ❑ . Clay Loam❑{Clay ] Adobe ] Hardpan ❑ M Previous Application Made: Yes ❑ No ® New Construction: Yes EX Nok❑ '` f TYPE OFINSTALLATION AND SPECIFICATIONS: I # I ) '� , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Q a' ° i• 8 bric�� cemer,u Septic Tank: Distance from nearest well__ ___ _____ _Distance from foundation....___..___..._._-.Iv>,at.17 ri�l ____..-._'__.___ E* No. of compartments------ Z---------------Size-----•800`- al. 5 -- -----Capacity_`8-0-b----------- f Liquid depth ---- --- ------ ` Disposal Field: Distance from.,nearest well___-------------Distance from foundation--------------------Distance to nearest lot line_+__..._____....-.��}� ❑ Nu_mbdr of-lines----------------------------------Length of each fine------------------------------Width of trench------------------- __---- 4*Type of filter. material--------------�=-- ',Depth' of filter material-_---------------------Tata€ length--------------------_------ -_------••--- I Seepage Pit: Distance to nearest well_--9dk---------- ista ce from foundation___$�.._._,___.Dis ice to'nearestJl Mine_ ��-_._ a brick # [� Number of pits Lining material -= - ------Size: Diameter'---------�--- -----Depth--��`---..--------------------- Cesspool: Distance from nearest well_________________Distance from`foundation------------ .Lining material ❑ M Size: Diameter_-__.--- --- _ --Depth--=---- --_ - „ '- ----- " Liquid Capacity _-� gals. Privy: Distance from nearest well---- ---------------............................Distance from nearest building--,---------------------------------------- Distance to nearest lot line................... `--__"-..-._ II ` ------------------------------------------ -•----- -------------------- - -- j Remodeling and/or repairing (describe]:.. _OW-_;L]R04;LjAtion_ lnstalli.In - new- cement—brick ------------------------------ .. --------sen'Liic,..tank.--and.._�.Q_oking---uR---to---3--ft_,�_.`vert ___drain---twenty �2Q� ft. deer with-- --- -- -------- 1�`� Af �c�lid liri _.. x'Qm.-riDpt � tank 1 -----------------------------------------------------------------------•-------------------------------------••------------------------------------ -----; 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)--------Delta--. eft_ .� Tank S rvice------------------------------------------------------------------- (Owns C t t By:--------------------Perry__Warthan :-.; " " ). UWner�Mgr and/or on roc /o or -----.-.>------------- --- Title------------------- - -- --- - -- --- . .:.� �- - -- .. - __-.__.-... (Plot plan, showing size of lot, location of system Wre'lat�on,to'wells, buildings etc., can be placed on reverse side). - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -------------- "'-_-_- --�_----_--"-_ f ----•- -----•--------------- ------ DATE_"=.fib•-- - - -------------- -------------------------- REVIEWED BY -� -- -- �` DATE_-. � BUILDING PERMIT ISSUED--------------- --- -------- ----------=------ -----------------=---------- -- -#r DATE---------------� _ ` - Alterations and/or recommendations:___________________ __"_-_--"____--_-_._,._ "-- --------------------------- .- -------- ---------------------------A------ --- ------------------------------------- .0 --------------- ---------- ---- ------------------------ '". ;- ---------- ------------------- ----- -- - -- -- - ------------------------------ ------------------------ FINAL INSPECTION BY-------- --------------------------------------------- Date--.-------- ------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California i ES-9-2M 8-51 Revised W-2100