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APPLICATION FOR SANITATION PERMIT Permit No. µ (Complete in Duplicate) / Date Issued Application 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. . 3 S"7? 4 .iTr4 L 7--D a- JOB ADDRESS AND LOCATION______Rt._-- -- -_BOx �27�- � Ripon, Calif. Owner's ,Name--.._9n1ald.--an-d-_MEU''thA Van-deP►�CYiuur--- __ _ Phone R ___ `A1.9!7!1922 -- - ----- Address-----Rt-e----21---Bt?-----X27---'C, F�1�caon�-- CaliP. � dd hs . om W t Ripon Rd. on W` I � de----0 c- on-e---.Rd�---- Contractor's Name D �. 8------------------------------------------------------------------------------- - ----- Phone-HO'----3� "2�5----- --------------------------- ---- - Installation will seVe ResidenceC Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel- ❑ Other ❑ Number of living units: -----I Number of bedrooms 3 Number of baths --- _�-___ Lot size _______120 X---80b Water Supply: Public system E] Community system E] Private KI Depth to Water Table.-5---- ft. 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 E4 No ❑ FHA/VA: Yes ❑ No } TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________________Distance from foundation___________________Material--_-----------------_________________-__________- E{Astinp No. of compartments---------- --- -----------Size--------------------------------Liquid depth--------------------------Capacity-------------- ------ .. Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line______-______-_-_ E{ sting Number of lines-----------------------------------Length of each line-----------------------------.Width of french----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length___________________________-___________-- ^` Seepage Pit: Distance to nearest well------190------Distance from foundation-�PZe__..Distance fo nearest lot linj82p'-�__ [� Number of pits------2-----_-------Lining materiaL___=QC ------Size: Diameter-------3.3__.______Depth-------- d____ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter--------------------------------------Depth----------------------------- ----------------------Liquid Capacity--------------------- gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------___--------- . ❑ Distance to nearest lot line-- ------- ------------------------------------ ----------------------- ------------------------------------------------------------------- d Remodeling and/or repairing (describe)_______________ ddin 2_ seepage pits to existing system ----------------------------------------------------------------------------------------------•------- ---•---•------------------------------------------------------------------------------------------------------------ -------------------------------------------•----------------------------------------------------------------------------------------------------------------------------•---------------------------------- --------------------------------------------------------------------------------------------------------------------------•----------- -------------------------------------------------------------------------------------- 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 Hea District. Delta a xic Tank Se -e (Signed) = P --- -- -- --------------------------(Owner and/or Contractor) By: Peru----Zari � ----- Tale Gen. Mgr. y -- -- ----- - (Title)] ---- (Plot plan, showing size of lot, location of sys "m in r ati o wells, ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------ ------ DATE-------------- ------------ .G-----------=----- ------------------------ REVIEWED BY---------------------------------------------------------- -------- DATE---------------------- BUILDING -------------- ---BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------- 1-- -------------------------- - Alterationsand/or recommendations:------------------------------------ ----------------------------------------------------------------------'--�--------•-� ---------------------------------- 4 -•-----------------------•-•---------------- ----------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------• ---------------------------•---------- --------------------------------------------- -•---- --- ------------------------------------------- ------ ----------------------------------------------------- FINAL INSPECTION BY-------------- --- ---- ------- -- Date-----��h-/ -------------------------------------- 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 1-57 F.P,CO.