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... :�.�� APPLICATION FOR SANITATION PERMIT Permit No. ____ } (Complete in Duplicate) r 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.applicafiion is made.in.compliance with County Ordinance'No. 549. JOB ADDRESS AND LOCATION- ---of--Mo_rado... .ores-s t:raCk-a---a-ad----cont-utile Owner's Name------ Mlle due `F,,,a.st to hoPhone__&--X392-•--- �} R:P: $--f e-r------------ --------------------------------------------------- , Address---W_-Af-_foredo---La-ue----=---------!--------- Contractor's ------ `-------- Contractor's Name Delta -------••------f--- ----------------------------------------- ---------------------------------------------- Phone------3-393 3-3. 9L5_ 5_ ---------- Installation Installation will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel-El Other ❑ Number of living units: __I___ Number of bedrooms '_tom___ Number of bafh�__2!__ Lot size _G� area � Water Supprly: Public system ❑ Community system ❑ Private [1 Depth to Water Table _25_ ft. y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe Ek Hardpan ❑ Previous Application Made: Yes E] No ® New Construction: Yes U No E1,11' 'R TYPE OF INSTALLATION AND SPECIFICATIONS: f '�► 4 Y �� (No septic tank or cesspool permitted if public sewer is availWe within.200 feet.) Septic Tank: 'F Distance from nearest well---aMpl-eDistance from foundation---_2.0..........Material.__-c$-m—ent br-i£k__-______ j® ` No. of compartments-.-----2----------------Size____._6_'_3x1}_'_$ �.___Liquid depth____- - � ' Ca acit ___ �y Disposal Field: Distance from nearest wella,Mpl,e_-.Distance from foundation___-_-_101...-_-Distance to nearest lot line____5--i------- Number of lines_______I_________________________Length of each line__120 e- s---Width of trench__�4!11_-------___- - Type of filter material__X'OC K-_----_---Depth of filter material_1. --___�_----Notal length-__120-r-_�_�________� + �Seepage Pit: Distance to nearest well__aMPJ e--___-Distance from foundation---1Q...........Distance to nearest.lot line----.5.t___-___` ® Number of pits_____2--------------Lining material___b_z'lGk----.Size: Diameter__5.1____________-__Depth___l5___ Cesspool: Distance from nearest well-----------.-----Distance from foundation--------------------Lining material___________________________-__---__. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________________________--..--_____-____-- ❑ Distance to nearest lot line-------------------------------------------------------- 5- t VRemodeling and/or repairing (dSye-t.e ---of lfva_ch._t��thrt_eM n�en3 _-_-Qtanks_cof---$th. 00 sal.-,pap=pa .--- ------------•--- ------------ / ! ------ -------------------------------------- ♦ { y -----------LLI__ �Ie_ 0-IA_+Fr �.r ------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)•---------Delta...-----------------------------6--------------------------- -------------------------------------------------------------------(Owner and/or Contractor) BY:------- Q..---W- -------------------------- ----------------------------------------------------------------------------(Title)------- ------01jer--- Zgr-*---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -------------------------------------- ----------------- ----------------- DATE_ ------- --------------------- REVIEWED BY----------------------- ---------------------------------------- -------------------------------- DATE-- BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- - DATE----------' Alterationsand/or recommendations---- --- ---------------------------------------------------------- ------------ ------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------`--------------------------------------------------------------------------------------------------------------------- --------------------------------------------- ------------- -------------------------- ----------------- --------------------------------------------------------------------------------------------------------------------- f ----------------------------------------- ------------------------------------------------------- ------------------.-------- -------------------------------------------------------------------------------- FINAL INSPECTION BY_____________________ __ _ ------ Date------------------------------------------- `� •• i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street . 300 West Oak Street 132 Sycamore Street�� 814 North "C" Street i Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100