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FOR OFFICE USE: f t .` •------------ APPLICATION FOR SANITATION PERMIT Permit No. .....1s3............. --------------------------------------------------------- (Complete in Duplicate} l �Y�f("(. ------------- This Permit Expires 1 Year From Date Issued Date Issued _._..-_..__.......... 4 Application is hereby made to the San Joaquin Local Healfh 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 --------- 1-,---Box .69 -, Tracy, ocQ Hi..way 7 miles_--w-._---off_Tracy I Owner's Name–PA— ._._& Marlene Hackney to old. street car on S. eAde ---'turn S. to __ __ u. On@-- Address--------------Rte----2.i- BOX-.691-s----TX!@tq---------•----•-•- ----- A g ..Delta Se tie Tank Servre , Inc. 37727 Contractors Name. - ----- ------------- ------- -- ---------- - Phone HD. ---------••-.......... Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._____ Number of bedrooms 2_____ Number of baths ___I. Lot size ---3-_--Age z@.....................`............... Water Supply: Public system ❑ Community system ❑ Private E] Depth to Water Table 35_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: (If yes,date--------------------} Nom} New Construction: YesE] No ❑ FHA/VA: Yes ❑ No 91 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_30-------Distance from foundation_,.......... .....M terial______ �____ E'Tlt .............. 1}E 1 ---.Capacity 1 99 � No. of compartments-----------2------------Size.......X�:...-----•--•-------Liquid depth-3 -------------- P tY------•--•----•-••-•--- Disposal Field: Distance from nearest well__ 0.1.._.._Distance from foundation .d Distance to nearest int line._- ........ io Number of lines______________�-__________--------Length of each line_________$Q --•___-____-.Width of trench.__�2_____- Type of filter material._.x'04.�_________Depth of filter materiai__�a_--____ g I.O1 ______ ...... C -------.Total length � Seepage Pit: Distance to nearest well______-,0 1-----Distance from foundation--3-91 to nearest lot iine.....5....-....- KI Number of pits..-._----------------Lining mr aterial_____ 9g _ k _--_Size: Diameter.---33 .......---,Depth._A0...B&Pd._flY'-. 2 Cesspool: Distance from nearest well.................Distance from foundation---.---------------.Lining material-------1.eaxi-a- -M0 .....__..._.___._.._._...._-_ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------_...gals. Privy: }Distance from nearest well-------------------------------------------------Distance from nearest building____________________-___---____________--. ~ ❑ Distance to nearest lot line---------------------------•---------------------------------------•------------------••---------------------=------•-•-----------------•-- Remodeling and/or repairing d tribe :----____-X1 -----g_y-at _»__ Qr..0�..d e- i ti $..hOUB� ___ 1 + " --�- - - ----------•- ------•---------------•------•---------------------•-•-•------------ ----•----------------------------------•----•-------------------------•--...............•---.....................----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with Sin Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) Delta Septic Unk Serve t_ TnCe Owner and/or Contractor S ...... -------------------- ----•----••-•----------•-----------------------•-------------(. / ) By:.----------•- F-erry---Q,__.Warthan-----------------------------------------------------------------------(Title).....-----Gen. - Mg.-�------ ----- ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.w--.__ --- --- --------- ---- --- - --------- DATE___________ REVIEWED BY-------------------------------- Y�j - ----•----•-•--••---•--••---•--....... DATE--------------------- --- > ..-- BUILDING PERMIT ISSUED................•• . - DATE Alterations and/or recommend'ations----------- -------------------------------e---------• ... �.....-- -------------- -- I� ...... -------------------------------------------------- ---------------•--------------------------------------------------------------------------------------------------------------------------------------•-------------------•-•------------------------------------------------- 7FINAL INSPECTION BY:..--------- Date � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lod[,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-61 ATLAS i