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f 3- 4 / � 1�rerLICATION FOR SANITATION PERI Permit No. •.�.. -J��' (Complete in Duplicate) /� (C+� Date Issued -... L This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a�nm�wy cjs�dct a4d inIf�the�w�ohhe�? �,e&cr ©fit This application i� s a in compliance with County Ordinanc No. 549 on south south B lilldeb0 ��++��P W Sr OB ADDRESS AN LOCATION-------t l.J- BOX-_3 $--t -�81-i#'e---------------------------- �oe and/or Viola Lo ins qi ------------------------------`_-- Phone.Ta. 3 3$80----- Owner's Name------- ---------•----•--------------- ----------•---•-- Abov e Address------------ = = == ---------------------------------•--------------------------------------------------------- ------ - - ' *Delta Septic Tank Services Inc. Ho, 3«-126-- Contractors Name Phone M Installation will serve: "Residence�� p ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:' _ -- Numberofbedrooms _--_-__CNumber'o# baths ---� __ Lot size _---- --Agr---------•--------------------------- Water Supply: Public system ❑ Community system ❑ Private C Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam a Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes E4 No ❑ FHA/VA: Yes ❑ Nod] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +ank or cesspool permitted if public sewer is available within 200 feet.) (rB3�Ent brick Septic Tank: Distance from nearest wail__- ��---_Dist n e f m f un a ion- ---------Mater, I -------.___- - --- .- ---. - p U€x9'&4�x > 80 b gal .❑ No. of compartments-----?------------ ----Size ------------------------------Liquid dept---------------- -----------Capacity--------- t--- Disposal Field: Distance from nearest well----�0'_.-._Distance from foundation--- �-� Distance to nearest lot �� -.Width of trench-- -- - - --------------- -Type - -------- >, Number of lines---�'-----------------_--_Length of each line---___----_.------ --- ••-- __ yP roCY 1$u T e of filter matenaL---------- -------------Depth of filter material length---------__--_--_---_--- ----------- pa Pit: Distance to nearest wel____:.- --- _�- Distance from foundation---- Dist once to nearest !o lin ____-_ ---.--.- ':Number of pits---.__ _---- ---Lining material-----r -----Size: Djameter--- --- -1- --- - Depth------------- Cesspo ` Distance from nearest well______-----_--._Distance from foundation__.---------___-..Lining material-------------------------------------- Liquid Capacity ..- als. ❑ Size: Diameter--------------------------------------Dep'th------------------:---------- ------------------ q p y------------------------ g ------------------------ Privy: Distance from nearest well-----------------------------------------_------Distance from nearest building_____--_-._-------_--___----.----------. ❑ Distance to nearest lot line------------------------------------------------ --•---------•-- -------------------------------------------------------------------- - Remodeling and/or repairing (describe):----------------- I1B11 , ACW pJy$ii_6I>i_-:GO_ replace Old B,yBtC©� -- ---•-•------------------------- . --------------------------------------- ---------------- -- -- ------ -------9`':------------------------------------------------------------------------------------------------------------- - - 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 Pelta Septic Tank $erviCOs-- InC#-----------------------------------------------------------------(Owner and/or Contractor) --- ------------------------------- rp Perry Warthan----------------------------------------------------------- {Title_1 Gen, g�'� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F` FOR DEPARTMENT USE ONLY., APPLICATION ACCEPTED BY--__.-_ -t�4 -- -- ` s -- ------------- DATE------- ±q------------ REVIEWEDBY--------------------------------------------- DATE---------------------------------------------------•------- BUILDINGPERMIT ISSUED----- --------------------------'-•--------------------------- = = - ----------• DATE------------------------------------------------------------- Alterations and/or recommendations -- : - � i-------------- -. --- � - ,: ---------------------------------•1-------- --------------------- ------------------------------------------------•---------------•-------------------------------------------------------------------- ' ------------------------ 0 ------ -------•------ . . . L FINAL INSP I'll Date------------- �� ------------------------------------ SAN ---------------------------------SAN JOAQUIN LOCAL HEALTq DISTRICT 130 South American Street 300 West Oak Street E 4M Sycamore Sfree+ 814 North "C" 5freet Stockton, California r' ' Lodi, California Manteca, California ;Tracy, California k /a r•a Lf B-9-2M Revised V59 F.P.Co. '� `