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APPLICATION PORNITATION PERMIT Permit No, (Complete in Duplicate) 4� Date f { C� ",G►/D' � it _.�.4 .. _ ssued ----��----- 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 incompliance with County Ordinance No. 549. + JOB ADDRESS AND LOCATION----------3A--Wes' 8th St. ` --- ------------------------------------------------------------------ ---------------------------------- Owner's Name---------------Rain---- X'OW11- ------------------ Address---------- ----------------Address-•----------------------- 8th St.. Stk1 Il___t- q&1 P -----------•-•------------------------•----------Ho--HO.----------------------- ----Name-------De1.ta-- SePlic Tank Ser'vi�el 731G,, - 3-7727 ------------------------ Phone----------------------------------- Installation will serve: Res ildence KApartment House ❑ Commercial ❑ Trailer Court [ Motel ❑ Other ❑ .i' Number of living units: _-_1 Number of bedrooms ---2-- Number of baths ---- Lot size 0 -- II ,y Water Supply: Public system .K] Community system ❑ Private ❑ Depth to Water Table'_ t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [2g Hardpan ❑ Previous Application Made: Yes ❑ No (4 New Cons+ruction: Yes : ] No ❑ FI--IA/VA: Yes ❑ No& TYPE OF INSTALLATIOWAND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesr 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.__--_--.-- -Y_. Exining Number of lines----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material------__----------------Depth of filter material------------------------Total length---------_.--_-_----..-_--_------ .--..- Seepage Pit: Distance to,nearest well-------A,O-------"__Distance from foundation__Aft_,-Pr__..Distance to nearest lot line-------5.------ Number of pits-------2------------Lining material--x_OCk-____-_-_Size: Diameter----28 -_--------.Depth__ Q-E ----------------- r' Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-------- ---- -----------__ ❑ 5ize: Diameter------------------------ -------------Depth-----------------r-----------------------------------Liquid Capacity----------------------------gals. d Privy: Distance.from nearest well-------------------------••-___ ---------------Distance from nearest building-___---------___-__-_----_______- .. . + ❑ Distance to nearest lot line-� ----��----------------- - - -----'-------=-----------------------•------------•-- ----------------------- - ------------ U Addi 2A'ese a its to es�letin system r: Remodeling and/or repairing {describe: --- ------- � -_P_ag_ ---p------------t ei -----------g-------- -- i i; --•---------------------------------;----------,----------------------------------=----------------------------------------------------------------------------------------•------------------_---------------------------- ------------------- _.--------- r -'-- ----------------------------------------------------------- --------------------------- 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 li the San Joaquin Local Health District. i ' (Signed)---------------De1 ta--•Sept i c__-Tank-__Service. Inc. ' --- -----------------------------------------------(Owner and/or Contract By------------Perry Warthan 1 (Title) n� �r� ---------------------------------------------------------- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.`can be placed on reverse side). - li FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- = „ DATE -. -/ --- --------- ----- REVIEWED BY ". i- ------ { �-- -------------------------- DATE BUILDING PERMIT ISSUED. ---- DATE ---------------------- Alterationsand/or recommendations/ ------------`-- ----------------------•---------------•---- -------------------------------------------------------------------------- ` U / ------------------- f -----------------------------••------- r -------- ------_------- ----------------------------------- - --------- --------------;----------:-------------------•-------•-------------- ---------------------•--------------------------------- ----------••--•----------------------------------------------------- : ---------- ------- -------------•---•---------------------------------------------.---.------------------•- - al -----. f - FINAL INSPECTION BY:-'= = Date---r �✓- 1 -f ii SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street l 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California ES--9—•-2M , Revised 1.57 F.P.CO. i.