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` r ,APPLICATION FOR SANITATION PERMIT Permit No..-.____-__ {'i�-!7 _ (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 descriLed. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION-----------333$-=-E.-- re / - -------------------------- -- ------------------------ Owner's Name-------------Li11_1&tj- I QmdQ-•- --------- -------------------------------------------- -------- Phone3-----aV ' ----------------- Address ------ = r. . -------------------•-------- Contractor's Name-----------------De1ta---------------------------- ----------------------- ------------------------- Phone---3"-1455--------------- -- Installation will serve: Residence El Apartment House ❑ Commercial ® Trailer Court [) Motel El Other ❑ Nfi mber of living units: _ ___- Number of bedrooms _1__ Number of baths _2___. Lot size _50XI-50 ------------------------------------------ Water Supply: Public system ® Community system ❑ Private 0 Depth to Water Tablc4�_____ ft. Character of soil to a'depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EX Hardpan ❑ Previous Application Made: Yes ❑ No ©[ New Construction: Yes ❑ No _ A } 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_________________------------------------------- F *exIst[jng No. of compartments--------------------------Size--------------••----------------Liquid depth------------------------- Capacity------------------ Disposal Field: Distance from nearest well-----'--------Distance from foundation____________________Distance to nearest lot line----------------- I. exist[Dng Number or lines---------------/----------------Length of each line------------;-/J_-#X.Width of -trench--- �------------------------ Type of filter material------------------------Depth of filter material-----------------------Total length___--- --"¢. �-----___- Seepage Pit: Distance to nearest well__=P_1_g------Distance from foundation------2-1---------Distance to nearest lot�lin �________ ® Number of pits_,___L--------------Lining material___b-r-ijak____Size: Diameter--42--- Depth____----2-If } -- t � � _-ti of . i Cesspool: Distance from nearest well_________________Distance from foundation------------N-1. .ining material________-_----______._______-__------ 1 ❑ $ize: Diameter Depth -------------------------Liquid-Capacity----------------------------gals Privy: Distance from nearest well-------------------------------------------------Distance from nearest building is ❑ Distance to nearest lot line________________________________--_-__ Remodeling and/or repairing [describe=--------------------Ve-rTi_)._c&1---Ira_).A---------------------------- •� �,.••- ----------------•----------• -------------------•---------------- I hereby certify that I have preipared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. (Signed)--------Delta---------------------------`---------------------- -------.(Owner and/or Contractor) By: 'erY'Y Ilt�_z'#h ,21 g---! -, -----_-------------------------------------------(Title)-----Qwne_r-�!Y•g.r.------------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r� ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- - -- - DATE-------------_-- --•-- ------------- ----------------------------------------- EVIEWED BY-------------------------------------` '�------ - ----- -------- ------------------- -----------------• ------------------ DATE----- ---------------=--_.------•--`----`.�-----..._ -------- BUILDING PERMIT ISSUED - ---------- DATE ---------------------------------------------------------- - --------------------------------- A+ r tion an /or recommen +ions. __,__-- --.___ ----------------- � L tT-_ } C --•------------------------------'------------------•---------------- ----------------------- --------- p. --------------------------------------------------------------- ------- FINAL INSPECTION BY:------- -------------------------------- Date----- f f / ' ' ' ---------------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 8-51 Revised W-2100