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FOR OFFlU US,; <br /> ---------------------- ----- --------------------------- APP CATION FR SANITATION PERMIT Permit No. <br /> ----------------------------------------------------------- (Complete in Duplicate) _O/A '2--- <br /> Date Issued -----I................ <br /> ------------------------------------- This Permit Expires 1 Year From Date Issued -i <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.............54_5__Earlh...Gol-dan---Gv,.t_6---Av.....-s ............................. <br /> Owner's Name-----------------Tr_U.422...and...Vi_z�_i.e.nne---Be-yno I d a-------------------------------------------------- Phone.U9.....4_-12I36...... <br /> Address............................545,-North-_Golden....Gate...j v...,.....................................­­............... ...................I........................ <br /> Contractor's Name-----.--Delta- Septic Tank Service -Ho. 3-3 55.. <br /> ----­-----------_------------------ ...............�Z??�qj--------------------­..................... phone....................... 9 <br /> Installation will serve: Residence [A Apartment House ❑ Commercial [] Trailer Court [] Motel [] Other E] <br /> Number of Irving units: Number of bedrooms ----Z Number of baths -1---- Lot size .........._--_ <br /> Water Supply: Public system El Community system El Private 0 Depth to Water Table ft. <br /> Character of sail to a depth of 3 feet: Send E] Gravel E] Sandy Loom E3 Clay Loom [3 Clay E] Adobe[a Hardpan [3 <br /> Previous Application Made: :(if yes,date---.--."----.---.---) No FK] New Construction: Yes [N No 0 FHA/VA. Yes [3 No [2 <br /> TYPE OF INSTALLATION AND ShCIFICATIONS- <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well,.--.,..........Distance from foundation--------------------Material------------------------------------------------- <br /> ExiRting No.,of co' mpartments--------------------------Size--------------------------------Liquid clepth--------------------------Ca'pacity....................... <br /> Disposal Field:. Distance from nearest well-----------------Distance from foundation_-__---.- .----Distance to nearest lot line...._..._........ <br /> Exiting Number of lines----------------._-_-.-----.------.Length of each line-------------_--------------Width of trench.-"-_..._................__........ <br /> Type of filter material-------------------------Depth of filter material.......... _-_-_---.-.Total length_----_-_-----.-.___-.:--_-.._..-----_._--- <br /> } Seepage <br /> ength------------------------------------------ <br /> Seepage Pit:. Disfairice to nearest well---- ---_Distance from foundation-.1.Q.........Distance to nearest lot line..5._........ <br /> 51,........... <br /> Number of pits----1---------------Lining material---rg.Qk-------Size: Diameter---�$----------------Depfh____4-&f-max. <br /> . .........r�.......-.1....... <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material...-.-..----.-------.-_-.-.---_-._"__ <br /> ❑ I <br /> Size. Diameter.-- ------------------------Depth------:�--------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Disfancejrorn nearest well-------------------------------------- ---------Distance from nearest building------------__---_-,................-" <br /> Distance to-nearest lot line__---._ *---------- <br /> Remodeling and/or repairing (describe):-------QddiAq----ro_�k%tt,216_d----6-ees-ag-C---•P_i_t....t..Q--- <br /> ...................................................................I-------------------------------------------------------------------------------------------------------------------------------I------------------------- <br /> ----------------------------------------- --------------------------------- ....... --------------------- --------------------..._..---------------------------------------------------------- <br /> -----------------­-----------------------------------I------------I--------------------------------------------------------------------------------------!-------_-----------­......---------­------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and 'rules and regulations of the San Joaquin Local Health District. <br /> (Signed)---------Del ta Sqp <br /> Ton-k-_ cv_j---------------------------------------------------------------(Owner and/or Contractor) <br /> By:.........Parr 4. [farthanmtle)J�tgg ---- -- ---- --------- <br /> - -------------------------------------------------------------------------------------------------- --- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on revers-o' side). <br /> FOR DEPARTMENT USE ONLY <br /> ----------- <br /> APPLICATION ACCEPTED BY----------------------------------------------------------------------------I---�__J__ 'DATE(��--- <br /> REVIEWEDBY----------------------------- --- -----------------=---------------------------------- DATE------ ------------ -------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------- ---------- .......I.............. DATE-._.--------------------------------------------------- <br /> Alterations <br /> ATE------------------------------------------------------- <br /> Alterationsand/or recommendations------------------- ---------------------------- -------------------------------------------------------------------------------------------!-------------------- <br /> --- --------- <br /> .................. - ----------- ---- --------- ----- ---------- -- ---- - ----------------- -- -- <br /> ------------------- <br /> ---- - ----- --- _ ------ <br /> --- ---- -- ---- ...... �r.4,0. ...... . ........... <br /> AL- -- -------- ---1;1 <br /> FINAL INSPECTION BY:.. �c----t---)---- Date...... ------------------ ------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California TraCYr California <br /> ES 9 REVISED 13-59 2M 5-951 ATLAS <br />