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S APPLICATION FOR SANITATION PERMIT +6• (Complete in Duplicate) Application is h'01y made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in,complianci with County Ordinance No. 549. JOB ADDRESS AND.LOCATIO ._____g,:_ � � gip-Lyth--�ist.._C�.rner__a£.._C-J.arxks.._T�ane__R:._.�9_:_F?i-I'_ . a _ ... t Y Owner's Name - _ d11Ch '. �__LC1,�`---- .................---......------.......-- ----- -------- Phone__9-6F93...Lodi- = t -Ca�_iforni2 Address.!-----_P. ':1_.�. _..i... . � d ( Contractor's.Name------......•.....J.li"�M. -- -----------------------------------------------------` -----------... Phone.._ '.- s :5..._.......... Installation.will serve:/Residence ❑,-A' artrnent House 0 Commercial ❑ Trailer Court ❑i Motel ❑ Other Cj7inery Number ofllving units: C] lumber of bedrooms ❑ Number of baths EIL Lot size------ ................. ................... Water Su ply: Public system EICommunity system E] Private DC Character of soil to a depth of.3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam(Z Clay❑ Adobe❑ Hardpan i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic.Tank: i` Distance from nearest well.__530I...-Distance from foundation------ _--------_.Material....C15mPnt-brick .. ® Y No. of compartments-----_-.-_ ----------Capacity....f3(Z4..........Size._.4_f_.t_ Tx4]-._-.Liquid depth.....2.g%4.1...... Cesspool: a Distance from nearest well.................Distance from foundation--------___------Lining material................................... c ❑ ' .+� Size: Diameter.........................--.........Depth.....-------------------------------.......... ...:.. i 'Privy: Distance from nearest well........................... Distance from nearest building_.,---------_........_--________- ❑ +b Distance to nearest lot line._.......:......................___.._.___.. Seepage Pit: - Distance to nearest well-----75!..........Distance from foundation-----8'..........Distance to nearest lot line....... ISI Special Number of pits-----------I--------Lining material........._............Size: Diameter-_v...._..............Depth_._..`dJ-f :__ Disposal.Field: Distance from nearest w.ell_...............Distance from.foundation.._:......._,_._ --Distance.to nearest lot line-----_-------, - EI Number of lines----------------.....-----._...._..Length of each line!......................-----..Width of trenchl-------...........__..........I I f + Type of filter material.........................Depth of filter material.....................__ -Remodeling and/or repairing (describe):-----1tJS allation.... f....Q (1)----- _An.k .•10,__-_of-_--.-.---- XM%...salid__lin-e---and..install,ing---nne---�1.)'...Y.ex t1C 31---drain�o--_s sand. and ___^ _yEt.tiaal__.._with._2z..IaCh...septic...nick:--a7-1----the...k1qY--t9---sand"= "heavy;_and.._loaded __truaks...p-as_s__Aver....the....t,anks...and_..nveF---the...vertical-_expeci-ally........... ........ ----- ..---- 1 hereby certify That l have prepared this application and that the work will be done in accordance with San Joequin Coun k ordinances, State laws, and rules and regulafions of the San Joaquin Local Health District. I a r (Signed).................Delta------...........--...--------..... ------- _----------------------...........--- - ---------------------------------(Ow x ()wrier ner and/or Contractor) By: ...._Psrxy.._�Yar..t}a -- ---------------------------------------------------------------lTitlej ------...---------�.r -- ---._...._----- (Plot plans, showing size of lot, location of system in relation to wells, buildings, eta, must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- .-- . DATE.... .................................. ------------ REVIEWED BY........................... - ------------ DATE-----i 1 BUILDING PERMIT ISSUED....... -........................ - - DATE............. � - ..... Alterations and/or recommendations:.............................__...............................------............-------.........----•---..... -- ................-----•-........................------•-----------------------------•---......_.........__..-•-•-----.........................---- .......------------------_----.. ------------------ ...---------•-'-•--•--------...------............•........-------------------------------------------------------......------------......--•......................................-. • ............................................-- - - --------- .-- -- . ...---------- ... - -------------------- - ,�-my ' PERMIT No/0-5-6----- ISSUED---_---:.-_ ___�_ _.�3'�-...(Date) FINAL INSPECTION BY:- Date. Y:.Date. 9 ..... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street `.. FS-9-2M 9-sn W_Ih99 Stockton, California . -