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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate). 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. A JOB ADDRESS AND LOCATION-----------Rt.-Rsx------297-t---LQdi------------------------------------------------------------------------------------------- Owner's Name------ -------Cxe_O.---Y-----I1c13--------------------------------------- --------------------------------- Phone------ --926-`-j-------------- Address------------------ #six 27, uicti,-- -C-alif.-------------------------------------------- ----------------------------------------------------------------- Contractor's Name-----------------De- .3------(-D-elt-al---------------------------------------------------------------------------------------- Phone-----.x-3955------------ nstallation will serve: Residence © Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1] Number of bedrooms E2 Number of baths M Lot size---50X1 0---------________________________________ Water Supply: Public system ❑ Community system ❑ Private Character of soil to a depth of 3 feet; Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam® Clay ❑ Adobe❑ Hardpan- is TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well______50_'_-__Distance from foundation------a_---------Material-------c-e:rent-hr_i_eY,______- ® No. of compartments---------2--------------Capacity-----800----------Size----6-'x4'-x4=_-----Liquid depth-----5'_& ._____- . Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material--------------------------- ----- ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- y Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______.._________.____-_____-___-____--.__ ❑ Distance to nearest lot line________________________________________________ .-_________Distance from foundation__-__ -r Seepage Pit: Distance to nearest well-----�,5__ ]<0_______.Distance to nearest lot line____________._ ® Number of pits-------- ------------Lining material---21rA_e_kSize: Diameter-----3-0............. p Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to neare of line______________ ❑ Number of linos-----------------------------------Length of each line------------------------------Width of tre ----------------------------------- Type of filter material-________________________Depth of filter material----------------------- Remodeling and/or repairing (describe)___________________ -a ant with-_vert_io_a1__d a-In--_c7.r-i_ll_e__d-_to__ s- ---- ---fid_-_f_ lied__with---2�n. s_e-Dt_ie-_tank__ra_c __-_-___ho_akinB--up--—a---cesaent_--tanksca_ith__ -1ick--2-irle------------------------------------------------ ----------------------------------------------------------------------------------------- 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 istrict. (Signed) _-_Delta----------------- r - Owner and/or Contractor By:-----------------------------1'_erry---.ar-than--- -- ---- .� ---- -- �.--------(Title)----Oy ler-44r------------------------------- (Piot plans, showing size of lot, location of system in relatio. t e s, bui . ngs, etc., must be filed with this application). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY------ ---- --------- - ---------- ---- - DATE' ------------------------------ ------ - ------------------ REVIEWEDBY---------------------------------- - - ------I--- -- -- ------------------------------------------ DATE------ BUILDING PERMIT ISSUED----------- ------------------------------------------------------------------ DATE-------------4--- -------------------------------------- Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------�----------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ -- ------------------------------ ------------------------------------------------------------------------- r PERMIT Nal _ ------- -----(Date) FINAL INSPECTION BY______ ______- --------/ - Date------------------- l / ��----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California �5-9-2M 9-50 W-1634 '