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v I yllfl APPLICATION FO,,jANITATION PERMIT Permit No. __ r .' (Complete in Duplicate) ry ff Date Issued Applicakion 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_--------_1856__Clover _Lane '" , off 3_•____uB N___5t._:___:Stkl_n --------------- .-, Owner's Name... .dward----- Furc a---COnB�able.i--------------------------- -- ------- ------------ ------------------- Phone.-- Ho. Address-----------_--x$56---GI-QY.0 ..L44-01-----------------------------= ---------------------------------------------------------------- Contractor's Name-------Del_----_38pt113--T6ltlk-_Service,--- ... nC-'-- - -- ----------------------------------- Phone__._HO•--•- Installation will serve: Residence []C Apartment House'❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I_____ Number of bedrooms _-- ._I Number of baths -__1_ Lot size __'4'Q_.x _160--------------------------------- Water Supply: Public system [X Co munity system E]_'Private ❑ Depth to Water Table 35_-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EM Hardpan ❑ _ Previous Application Made: Yes ❑ No [j New Construction: Yes k] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Sep#ic Tank: .'' Distance from nearest well-----------------Distance from foundation______________.___.Material__--_.--__-._____-____:_____.______-.__-_._.._. Ezoting No. of compartments-------------------- -----Size-----•---------•----------------Liquid depth--------------------------Capacity----------------- Disposal Field: Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line_________________ E ;.sting dumber of lines-----------------------------------Length of each line--------- -------------------.Width of trench.---------------------------------- sType of filter material------------------------- of filter material------.-----------------Total length------------------------------------------- 1 Seepage Pit: Distance to nearest well---------na-------Distance from foundation_-___APP1QDistnnce to nearest lot line__-_ [ Number of pits------ --I----------Lining material__Y`OEk---------Size: Diameter----34-------------Depth-----------��---------------- ECesspool: Distance from nearest well------_-------_Distance from foundation--------------------Lining material-----.____________--__________-_--- i ❑ Size: Diameter-----------------:--------------------Depth-------------- ------------------------------!-----Liquid Capacity----------------------------gals. Privy: Distance from nearest well ------------------------------------------------Distance from nearest building------------------------- 1 ❑ Distance to'nearest lot line_ ___________________ ------------- - Remodeling and/or repairing (describe)------------------------------------------r d�3fng-_. � e:_P t__to-.. xisting_•_e a em- i -------•---------------------- --------------------------------•---------------•------------------- I r .� -------------------------------------------- -------•-----------------•--.-----•-----•----.--...--.----•-----•---------••--------•----------------------•-----------------------••--------------------•- ------------------- I hereby certify that I'�have prepared this application and +hat 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. belta3 Septic Tank Se vice Inc [Owner and/or Contractor) !. (Signed) ------------------------ ---- --------- - ------------------' By:........................ Perry Worthen _(Title)_aen _ Mgr. -- ------- (Plot pian, showing size of-lot, location of_s)stem: in relation to wells, buildings, etc., can be placed on reverse side). h FOR DEPARTMENT USE ONLY � - r APPLICATION ACCEPTED BY------------------_----_ _ I --- -------------------------------------------------------------- DATE--------------------4`'------------ REVIEWEDBY--------------------- ------------------------- ----- - -; -----:----------------------------.- •----------------------- DATE---------- -- -- -- ---------------------- BUILDING PERMIT ISSUED -----••-----•------••-•--- --- --- - -------------------•-•----------------------------------------- DATE----- / � Alterations and/or recommendations--------------- --- --------------- ------------------------------- •----•----------------------•- - -------------------- 7- `--------------------------------fir- �_�_------------- ---------- - - - - -- ----------- ----------------------- , .___..---•---•----------- •-••- •----....-----•--...----------..._....---•-•- ---•----- --------------------- •------------ . ----- -------- --------------- `i FINALE INSPECTION BY:',--- Date S > t ------- :L SAN JOAQUIN LO HEALTH DISTRICT 130 South American Streef 300 West Oak Street 132 Sycamore Street 814 North "C" Street `, t Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145996 A-0- L