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i� I! APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _--- A plica{ion is hereby made to the San Joaquin Local HealthAr/sr District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. /-(Y07-Lr .S T ,1 JOB ADDRESS AND LOCATION----__-3600 Railroad-Ay , ---------------------------------------• -------------------------------------------- *---------------------- Name-""----._J�mtT1e__�.GC �Tphne0l:1___"__ _ •------------•--------------Address $_R ---- - Phone_.H�!---- ---------------------------------••---------------------------------•--------•------- -----------------_-----•---------•-•---------------------•--- Contractor's Name-------------------Del-ta -- -' ---- 9--- ------------------------------- --- Installation will serve: Residence K) Apartment House [-I Commercial W z- -" " Phone--- - ❑ Trailer Court El' Motel L] Other.❑ Number of living units. ?._ Number of bedrooms ------ Number-of baths _l_.-- Lot size -_-_._ Water Supply: Public system "" -'-----•----�-•-----• ----•- Y Community system ❑ Private E] Depth to Water Table 4-0ft. Character of soil to a depth of 3 feet: Sand ❑ Loam E] Clay Loam E] Clay ❑ Adobe ® Hardpan Gravel 0 Sandy LE] Previous Application Made: Yes ❑ No 0 New Construction: Yes' ] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well .-".-- Distance from foundation--------------------Material- . ehir,E3ng No. of compartments. ----------------- Size Liquid depth----------- --------Capacity--------- ---------- Disposal Field: Distance from nearest well-__--____-_---. , Distance from foundation----------_-.-•----Distance to nearest lot line----------------- exi��ng Number of IInes---------------------------=------Length of each line-----------------------------of filter material--------- ---__ ; Width of french Type -- ------Depth of filter maternal-....------- --- -----Total length--------------------•------•------------- Seepage Pit: Distance to nearest well-.--7�_:-_______ _ r Distance from foundation----.___!Q;.--.Distance to nearest lot line-"__.-1-"__ E] Number of pits---1----------------Lining material-----1:r1CK t � r � --------Size: Diameter--- ---�------------De to----- ------- -- Gess Cesspool: p J � p Distance from nearest well ---------Distance from foundation---------------.-__.Lining material--------------___-__ s -------------Depth--------------------------------- ----------------- ❑ Size: Diameter------------------- --" - -------- - `------Liquid Capacity----------------- ---------.gals. Privy: Distance from nearest well----------------------------------------------- _Distance from 4nearest buildin ❑ Distance to nearest lot line-------- --------------------------------------- • g Remodeling and/or repairing (describe):_...-"-- "---".____adding Vert, An t0 eXA Stln eys tezn --------• ------dra- ----•-------------------------------------------------•---------------- ; I hereby certify that f here 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)----------------------- del t. - ------------------------------- By:----------------------------------Pe�ry_...ti'�r�rth�.n _ _ __ ' (Owner and/or Contractor) (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 r APPLICATION ACCEPTED BY------- ---- -- --- ----- DATE----- ---- VIEWED BY ---------- -- ----------------------- ----- --------------------------- DATE BUILDING PERMIT ISSUED------- ------ -� J _---- --- ----- ----- ------------------------------------------------- --------- Alterations and/or recommendations:-- ---- -- - ----- T ---- - ---- `-`-----"------••-----•------ - - ---------- ----------- " --------•-------------------------------------- --------- ---- - ------•---------- I --- ----- ------- --------- � ------r _�._-_. ----F' - - t ---------- L` --- - :; - ------- --•------- _ ------------------ -- --------------------------- -------------------- ----------------------------------- ------------- v ___:__: __"....:..:.....::::.....•------ ---------•----•---- .------..- �. -------------------•----- FINAL INSPECTION BY:..-__."-_---- ----------------- Date.. ... --------.----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California 814 North 'C" Street Lodi, California Manteca, California Tracy, California ES-9-2M 155446 AT WOO V 12-54