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FOR OFFICE USE: ... APPLICATION FOR"• ANITATION PERMIT Permit No. ......_---_ ------------- - - (Complete in Duplicate} Date Issued'..% _ ------------ 1 __ __ ____________"- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District fore permit to construct and install the work herein described, This application is made in compliance with County Ordinance No. 549. -- JOB ADDRESS AND LOCATION------ - ---------- rdina] -- - ------------------ _,__. • Owner's.Name.----------- -------••-•------------------- ---- ------•---------- ------------------ Phone__HO-..... Address-----------------------263-- c"�,-* Ard 0.7-----------------------•----------------------------------------------------- ----------------- -----------•...3--------........... De7.ta Se tic Tank Service' Inc.--`---------------------------------- Phone_.HO�__- ....-7727---- Contractor's Name--------------• -•-- i -P---------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court.❑, Motel ❑ Other ❑ Number-of].iving units-z' -1— Number of bedrooms ___2-- Number of baths :__ --- Lot,iiie ._.aQ--x---249----------------------------------- Water Supply: Public.system [X Community system ElPrivate [:] Depth to Water Table'�'5_-- ft. Character of soil to a depth of 3 feet: .Sand E] Gravel E] Sandy Loam El Clay Loam ❑ Clay ❑ Adobe® Hardpan [I Previous Application.Made: if yes,date--------------------) No [I New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION RIND 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------------------------------------------------- Exiling No. of compartments---------- -Size .............. --- ------ Liquid depth---------------- ---------Capacity....--------...-'--... Disposal Field: Distance:from nearest well__---------------Distance from foundation--------------------Distance to nearest lot line-------.-_--_--_ Exi4ging Number of lines.---------- ------Length of each line-----------------------------Width of french._'_.--------:-----------.--------- lType of filter material-------------------------Depth of filter material-----------------'----Total length-_----------.------.--•------------------- n l Seepage Pit: Distance jo nearest well------no--___-___Distance from foundation__�.Q�_�..___.Distatk a t.. nearest lot'li__MA �_.._.._ f pits-- ---I--------------Lining material---- rock------Size: Diameter-------3311- Cesspool: 3_-_-------Depth--2S-----m �-------- Number rr � Cess ool: Distance W f � from nearest well__________._._.Distance from foundation____________________Lining material----------------------------------- P i j ❑ Size: Diameter--------------------------- ----------Depth_--------- ---------•---------------------------- -Liquid Capacity---------------------------gals. { f.� ___--L-:Distance from nearest building ------'.--- qq Privy: Distance: from nearest well--------------------------------------- - g--------•---------•--------- - ❑ Distance'to nearest lot line---------------------------------- -- ------•-------•-•------------•-------------- ------•------------------------- -------- Remodeling and/or repairing (doscribe)_------------------ -------adalng---- g -------------- F. _ - - -- - ---------------------- ► __ I hereby certify that l 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)--------- Delta__Sept.i.c... .__�r>`.C�---l--------------------------------------------------------(Owner and/or Contractor] eti ii --- �'prix .. --------------------- ...... By=----------P-eT�"_�---.0.__.W�'1;h_a a--------------------------------------------------}----------------- ----( } (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can-6e placed on reverse aide). I r FOR DEPARTMENT USE ONLY it APPLICATION ACCEPTEDi$Y- --- -•------------"------------------------ DATE �C�C REVIEWED BY-------------#--------------- - ------ DATE = ; BUILDINGPERMIT ISSUED;--------------•---------- --------------------------------------------•--------------- DATE Iterations and/or recommendations:__..------ -----=- F �--�--- --- ------•------- -- ----------------- -----------------------------------------_- ---------- ------------_-------------. . -- ---------------------- •-. ---- - ---•r ................. .-------- -- -----• .... -- -•------•------------•-------------- •--- ----------------------------------------- ---- 3 �a- ----------------------_ FINAL INSPECTION BY ------------ - - --• ---------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Stfeet f Stockton,California Lodi,California Manteca,California Tracy,California E8.9 REVISED 13•59 F.F.G O.ZM 6•60 `