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{ APPLICATION FOR SANITATION PERMIT Permit No. _-�_�_ . ....2-- (Complete in Duplicate) ly Date Issued ----�f--- -� 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. JOB ADDRESS AND LOCATION--.-----255 S. Oliver ------------------------------------------------ ------•---•---------------------------------------------------------------- Owner's Name---------MrgR---Mary---Tuttl@---------------------------------------------------------------------------- -------------------- Phone- Ho-e---..5.`-"- -M---- ! Address---------------------9-55-9-55-At----- . ----------------------------------------------------------------------------------------------------------- Contractor's Name-----PAIl it---- ------ ------------------------------------------------------------------------------------------------------------ Phone.-Ho. 3-7727 ------------------ Installation will serve: Residence M Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----- Number of bedrooms __--!__ Number of baths -1---_ Lot size ----35-_X---160--------------------------------- Water Supply: Public system ;] Community system E] Private ❑ Depth to Water Table 45-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [4 Hardpan ❑ Previous Application Made: Yes ❑ No jo New Construction: Yes ® No ❑. FHA/VA: Yes ❑ No Fx] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material-------------------_-------- ___-.-. ExisMing No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- EXi8�iixLZ Number of lines-----------------------------------Length of each line-------------------. ---------.Width of french----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length_-___----_----_---__.-------_---------._ Seepage Pit: Distance to nearest well-------r1Q---------Distance from foundation---�p;-8_.Disst��e to nearest loj line-5------------ ® Number of pits---.-.--3-----.-------Lining material-_-rQCk--------Size: Diameter-------- -------------Depth 2 --------11~11[. p Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- G° ❑ Size: Diameter--------------------------------------Depth---------------=------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.-------__-________---_---_--.----.-__--. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)--------------Adding---ae_ep-sZQ___PAt---Only!-_�o---C�Cfe��n� B,�B�CID ---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------- ----- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I 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 District. {Signed)-----Ferry_--Warhan-----------._----Delta Se tie Tank Serv. , Inc. , - -------------------------- -------------------------- - )Owner and/or Contractor) BY:..........Perry__ya hen. (Ti+le)--------den• Mir- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). rte} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- --------------------- ---- ' .--------------------------------- DATE----- --2------- - - -- ------------------- REVIEWEDBY--------------------------------------------- ------------------------------ ------•---------------------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------ ----------------------------------------------- DATE--------------------------------------- Alterations and/or recommendations----------- ----------------- __ -__-___-_______________ __--- --------- '- - --------------------------------------------------------------------------------•-------------------- " � -------- - - --v------------------------------------------------------------------------- --------------------------- ---- ---------- �] r ------------------------------------- ------ ------- – – - ----------- FINAL INSPECTION BY:.----- - Date --------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 -Vest Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M Revised 1.57 F-P.CO. y