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r APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 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----------------215-5-----and---2357--=d_aterl44__Ra ---------------------------------------------------------------------- Owner's Name---A.1---1;`ckv_e_11Q--------------------------------------------------------------------------- Phon "-2001 Address---------------2_012._ -----Lafay-e t-e---n Stk'_n v--------------------------------------------------------------------------------------------------------------------- Contractor's Name....Deltta.__Zept_ta---Tank_3ex- -*-------------------------------------------------- -----.•--------------- Phone---- -3 55-------------- Installation will serve: Residence ❑ Apartment House E] Commercial [4 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms ❑ Number of baths 2] Lot size__541----X.-_ZQQ1-----------------__-_-_----_-- Water Supply: Public system [2 Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [:I[ Hardpan ❑ . 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-_-_--------_--------_-_____---_----___-----_---. Daxist ing No. of compartments--------------------------Capacity-----------------------size--------------------------------Liquid depth-------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- U, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------_-----------_----_--___---_-----. ❑ Distance to nearest lot line____-____--_____-_--_------------------------- Seepage Pit: Distance to nearest well---------------___-_-Distance from foundation_-__-_Z o_._---.Distance to nearest lot I iner..tQ......... ® Number of pits----------1---------Lining material---hrtek------Size. Diameter---.-_41___---____-?Depth--------a-sem_--__- r Disposal Field: Distance from nearest well----�---------Distance from foundation-----l�?_-r------Distance to nearest lot line___ ___________ ® Number of lines------------1-----___-i___----_-_Length of each line----__--� �____---.?--_.Width of trench-app-L4rr Type of filter materialTh,-A_-t'°!?40epth of filter material--------f_P'1---___ Remodeling and/or repairing (describe):----------repair_ing----------------------------------------------------------------------------------•--------------------------------- -------------------------------------------------------------------------------- ----------- --------------- - ----------------------------------------------------------------------------------- - --- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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)-------------------]De1ta__Z_9pt1a---TaS1.k__5e - A-Ili�n (Owner and/or Contractor) -------- --- ------------------ By:--------------- ----------Perr-y--Warthan-- --- - ----(Title)----Qwner-Mj&r--------------------------------- ot plans, showing size of lot, location of system in.relati tings, etc., must be filed with this application]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------i ' '----------------- ---------------------------------------- DATE----- �'!'"� ' ��-------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------ = ------ l-------------------------- iBUILDING PERMIT ISSUED---------------•-------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------•------------------------------------------- ---------------------------------'------------------------------------------------------------------------------ --.-.. z, --` -' ----------------------------------------------------- -------------------------------- -------------------------------•---------------------------------------------------------------------------------------r---------------------------------------------------------------------------------------------------- �`� ` y �` b r = ------------------------------------------------------------------------------------------------- PERMIT No.___�Z� ------------- ISSUED----- --------------(Date) FINAL INSPECTION BY:--_-_-----`_-------------------------------------------------- Date-------------- -✓ ,�_r � SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street Stockton, California ' ES-9-2M 9-50 W4639