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PA 1 a LO APPLICATION FOR SANITATION PERMIT Permit No. ..... ..__1___6-_d (Complete in Duplicate) ' 7 _s Date Issued ----------------------C 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. t JOB ADDRESS AND LOCATION -----545____N. _. _Golden Gate ------------------- ----------------------------------• --------------------- Owner's.Name------- r'V11 $ --_ e ---------------------------------------------------------------ldPhone �'_—x-23`- Address-- i i Contractor's Name--------------Delt_a,._-;net Phone 3-39-35 1 Installation will serve: Residence�Q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Numb ler of living units: -----1 Number of bedrooms ._2-___ Number of baths __1_._ Lot size _75�00 Water Supply: Public system ❑ Community system ❑ Private [2� Depth to Water Table _3L0__ ft. Character of:soil to a depth-of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ `Clay Loam ❑ Clay ❑ Adobe ( Hardpan ❑ Previous Application Made: Yes ❑ No E]K New Construction: Yes [N No ❑ k TYPE OF INSTALLATION AND SPECIFICATIONS: !(No septic tank�r cesspool permitted if public sewer is available w4hin 200 feet.) f est well------g�_r_-_Dist c from f undation--- 1----`---_- Materiel ADDISeptic t GKE 2XT Distance from near R � X � M -- - ---- --- ] lo. of•com artments- 2---------- -Size--------- •---•- -----------�Liquid depth_5-1-& Capacity �OQ gad py------ ------ CEisposal Field: Distance from nearest well____.____..___._Distance from foundation------------ .------Distance to nearest lot line_________________ ext ing Number o'i lines-----------------------------------Length of each line --------------------------- of trdnch._____.______-------- - - Type of filter ma.terial-------------------------Depth of filter material-----------------------Total length------------------------------------------------- Seepage Pit: Distance to nearest well_._-_7 Q�_ _______Distance from foundation____ 8______________ 1 _ _ag Distance to nearest lot line____ ______.._ " E4Number of pits--------�------------Lining material_brCk-------Size: Diameter------ -------------Depth_-----20 t-__'-------- ---- r Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining material,--------------------------------- El ____.________________.__._ -_❑ Size: Diameter------------------------------------- Depth----------------------------------------------------Liquid Capacity--- -------gals. Privy: Distance from nearest well-_______________________________._.____ --_----Di€stance from nearest building.__._ ---____________:_ Distance to nearest lot line----- - Remodeling and/or repairing (describe):-----___Addieg.-ons-__(1) extra_ cello exp sting eeptie tank - - syat m.._and__a.na_t. ._].i.ngcarye----Ll_)..._ r_ 0-!--_ver: _jgcfk:-- ?Oi �r©m the-- o vers weld with ful - anr�rQva.1__ s�rne ' ------------------• ----------------•---------------------------------- --------------------------- -----------------------•---------------------------------------------------------------------------------------------------------------------•--------------------•------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County, w ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, (Signed)---------•----------------------Delt-a Septic_ Tank- 5erv. In-C. ' (Owner and/or Contractor) - ------------------- By:----------------------------Perry. W2_rthan ----r (Title) Gen. Mir. ---------------- ot plan. showing size of lot, location of system in re ation to wells, buildings, etc., can be placed on reverse side). 1.FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------- ----- y,� DATE -..� REVIEWED BY---------------------------- - ------------------------------------ ----l�-_�----------------- DATE /_ — �f BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------- --------- DATE--------- -- Alterations and/or recommendations:-- -- --------------------- -----------------------------------------------------------------------------------------•--------------------..---------------------------------- --------------------------------------------- ----------------------------------------------------- ----------------------------------------------------------------•-------- --------------------------------------------------------- --------------------- - ------------ FINAL INSPECTION BY:-------------- _. @ 1'v''/ Date----- -- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT { t 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California ES-9-2M 10.52 Revised W-Vo0