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APPLICATION FOR SANITATION PERMIT Permit No. ..-,e-Q._. -.QI % w (Complete in Duplicate} Date Issued .1V-71x.r 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. 23S"1? It • "LTn,mac JOB ADDRESS AND LOCATION.........Rt. 2s Box_ Fi27��,___Rip9R# Calif. 'L�-!"70--�,! ----- -------------- ................... Owner's,Name.-...Rnald.__And-_MBPth-a_.Van derSChuur,-------- -------•.----- .._ Phone AU---Zka,,9.:.1922 Address.....R.te_ x---Hqx.- 27wC„--_Ri on, C lif. .r. d h8 om W �t Ripon Rd. _on Tat. I �.'zs�' gc one 3-1269 Contractor's Name------....8....................................•--•-- ---------------------------------------- Phone...4`............-• -•---- Installation will se a Residence43 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel. ❑ Other ❑ Number of living units: ..... - Number of bedrooms_3__. Number of baths ... ___ Lot size ___-_- 120 x 800 Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Tablel5..._ ft. Characfer of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam[] Clay Loam ® Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes No ❑ FHA/VA: Yes ❑ No 21 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.----------------Distance from foundation....................Material...___.-..__................................... E g No. of compartments.----.artments._-____._....__......Size................. -Capacity P ---------------Liquid depth---------------------•-•- .................. ---- t- ... Disposal Field: Distance from nearest well.................Distance from foundation....................Distance to nearest lot line.............. E48ting Number of lines-----------------------------------Length of each line..._._..-..-----------.---_---Width offrench.............................__.... Type of filter material...........................Depth of filter material--------..._-._.--_.-.-Total length.......................................... tj Seepage Pit: Distance to nearest well------190-------Dis+ance from foundation_P>Ple_..Distapce to nearest lot (x Number of pits......2_----------.Lining material----- ......Size: Diameter__.-__.'-3...........Depth------- 9.................... r Cesspool: Distance from nearest well.................Distance from foundation....................Lining material................................ _... ❑ Size: Diameter......................................Dept h....................................................Liquid Capacity..................--------.gals. Privy: Distance from nearest well.................................................Distance from nearest building.......................................... ❑ Distance to nearest lot line--------- -------------•------------------- -------------------•.... ----------------•----.-...------...-----------------•---------------- d addin 2 see f'J its to exists system Remodeling and/or repairing (describe)------•---------•----• ---g---------•-••---pag----•p------•-•---------------------------�...._......----- -•-••--•••--------------------------................................................................................................----•-----•••-•--------••..-----•••--------•--•-••-......•-------•-••••.......... I hereby certify that I have prepared this application and tha+the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Hea District. (Signed ------.•Delta-----epic_Tank Be - ------ -..........................(Owner and/or Contractor) By; (Title)..-Gen. M r, (Plc+ plan, showing size of lot, location of sys m in r afi wells, ildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY •-•- - ...................... DATE--------•--••------------ .._....---== REVIEWEDBY.............................. •••••-........................................__-------------_-_----_--------------- DATE---------------•-•- k........................ BUILDINGPERMIT ISSUED-----...............................................•---...._---_----•------•------------------- DATE------ •--........... .......---..................... Alterations and/or recommendations:----------................-•-------•---------•-----•-------------------------••---...--•----•----------••-..-..-.......-•-•---••-....-..-_--•-_--.-_-- ------------------------------------------------------------------------------------------------------------.........................................------------.-..0-111A---------------------•--------------------- •....................•---•-••---•---•---•---•----•-•----....-----•------....--•-•-------••-•---------•--------•-----•......................................................•-•-••--•------•-----•---•---------•-------- ...•-----• ----------------- ---.-_.----------• - ... ...................•-•----._.....---..........---------------•---•----•--•-•--.......---•-••--•. . - FINAL INSPECTION BY:..--- .. ....... ...- -- ..-..-- -- Date.....�ehl -sl......................•--._._..------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-214 Revissa 1.57 F.P.CO.