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` APPLICATION FOANITATION PERMIT Permit No. ...y-/--- (Complete in Duplicate) Date Issued .....1. . . . Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describ This application is made in compliance with County Ordinance No. 549. '` JOB ADDRESS AND LOCATION----------Rt...... ... .$_t n.................................................................................. Owner's Name...............John..-R Flores_.----------------------------- ------------- ------------------------------------------. Phone..H0.....3.-.3.62.. Address---------------------------Rt•'....one' Box---80............................................................................................................... Contractor's Name. Delta.--•-•-----------•----- ------ ----_. Pholre..Ho.-- _ Installation will serve: Residence,[]K Apartment House ❑ Commercial d Trailer Court ❑ Motel ❑ 'Other ❑ Number of living units: ...1__ Number of bedrooms ----- Number of baths _I-... Lot size ------_5_Q--x__.15.0 --------------_____ ___ �-.._ Water Supply: Public system ❑ Community system ❑_ Private Z] Depth to Water Table ---5.0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®. Hamdan El Previous Application Made: Yes ❑ No [a New Construction: Yes ,a 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__-_---_-Distan a from foundation...�-.0---------Material �- �!'�- ,-__ xi�ting No. of compartments-------''�----. -._Size---- __Y-S__` ___Liquid depth__-_ --------- -----Capacity.._.-_0-�.__. Disposal Field: Distance from nearest well-----------------Distance from foundatione.to nearest lot line Extoing Number of lines-----------------------------------Length of each line../- ....... i th `-ranch-- -------- ________________ Type of filter material------------- ---------Depth of filter material--. Total length........................ Seepage Pit: Distance to nearest well-------U---------Distance from foundation ._ZO. * Lance to nearest lot h e �11 ;E] Number of pits......Y-......--_-Lining material--- Diameter------------------ ----Depth -_- ...._.......-_.._.._ 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---____-_---_-_-___---_-----_-F.-_.-_-_. ❑ Distance to nearest lot line--------------------------------------------- •-------------------------------------------- • ------ I it Remodeling and/or repairing (describe):_- Adcdng...s8epeZe...pit ._►- _It.__ s._. Teed by-_John Re__ and. A i e__•Fl-©ree.--.that-•.installing 8 ___ .pit ----- e . om t .. r well ie o Ke ..................................... y -----------------------------------------------------------........................N --- • . . _..o�---- o---- --' I hereby certify that I have prepared this application an at the work will be done in actor ante with San aquar#�r ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) Delta f2ti�..0... AI1 B ,C,j------------------------------------------------------------------------(Owner and/or Contractor) By:...................................Py--Warthan-- /�.___�l- (T'rEle1 t•en-Mgr•----------------- --- --------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------- ------ ------- ----•---------------------•-••-•••--•••--------•-- DATE------... -------------------------------------- REVIEWED --•-------------- REVIEWED BY- --- ----- DATE----------_---- BUILDINGPERMIT ISSUED.................. ----------------------- ..............--..................................--- DATE............. --•-- --- Alterations and/or recommendations:..................... --- -- ----- --- -------_---•---- •. _ . FINAL INSPECTION BY:---- - . -------------------------------- Date....................... ..... ---------- 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 W-2100