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APPLICATION FORONITATION PERMIT Permit No. ..._��. - .S_. n Com lete in Duplicate) Y' ( P Date Issued .57.."l-231.4-11 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------- 1pine-_Rd, between Fairchild and Linden Rd. , Stk' n. , Owner's Name r� ��9��Pone-- = � _ ----- _ -- Address---------Alpine_-Rd,_,__between Fairchild Lane & Linden Rd. , Stk' n. G+ontractor's Name------- elta Septic Tank Serrvice, Inc. -_ Phone._�O!....3�"?�/27 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 29 Number of living units: -Q-Number of bedrooms"'0_"Number of baths ©'"Lot size ---11---A,cree Water Supply: Public system ❑ Community system ❑ Private 1!] Depth to Water Table 45--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay-Loam ® Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No [a New Construction: Yes pc No [j FHA/VA:Yes ❑ No X] 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-3AS---.___Distance from foundation-1101--....._..Material-_-__-C�._..Gemen----- C7.. (�{� 91 No. of compartments..._..._._ -__-_-_.._--Size....,-XA-k-------- -_Liquid depth_...*-------------------Capacity... O"" Disposal Field: Distance from nearest well--501-------Distance from foundation..10-'-..-------Distance to nearest lot line----=p,7.-Q Number of lines--------------1------------------Length of each line------.------�1.Qq_._._....Width of trench--------2___.�__...-------------- Type of filter material------x'OCk------Depth of filter material...... 8 -.__.__--Total length.-------------39-_-------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- 1-71 Number of pits----------------------Lining material_..__.____.____.-----Size: Diameter__.................__Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material___.___---_----_.__.__.___-__----. ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------._Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ nDistance to nearest lot line-------------------------------------------------------------------------------------- --------•------------------------------------------ Remodelin and/or repairin (des cribe):__..._one toilet,_one hand basing used _by_ no___more__than four-- 4-(- �--_people.. five--days---each- week and-no-t-over---$hour --- ------------ --------- -- --------------------------------------------------------------------=---------------------- ----------------------------------------------------------------------------------------------------------------------------- -------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. Si ned pett_a__S9pti c----dank---6-ery ce-,---Inc.--�-----------------------------------------------------------(Owner and/or Contractor)(( 9 ) By=--------------------PerrY--Warthan----------------------------------------------------------------_---.-..(Title)------ Chen.--Mgr------------------------------ (Plot plan, showing sizes of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ----- - ------------------------------------- DATE-------- REVIEWED BY----------------------------- -------- -- - -- --- -��--- ----------------------------------------- DATE.---------- --------- ---- - BUILDINGPERMIT ISSUED-------------------------------------------------------------- _---------------------------------.. DATE------------------------------------------------------------- Alterationsand/or recommendations:---- ------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------•------------------------------ ----------------------------- - ----------------- -----------------------__.------------------------------------------------------------------------------------- --------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------i-- --------------------------------------------- ...........------------------------------------ ----------I------------------------------------------------ FINAL INSPECTION BY--------------- ------ ------ --------- -------------------- Date--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1.57 F.P.CO.