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APPLICATION FOR SANITATION PERMIT Permit No. ...-.,/ G = ------- (Complete in Duplicate) �4/.`' �Q-d 'This Permit Expires 1 Year From Date Issued .Date Issued ._:...�--..---- 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 ------------ 09 South 0��elZ--------------------------------------••---------------------•-----------------••------------ Owner's Name--------------Mx`e• AngTe,_M M Chell-----------------•-- - -------------------------- Phone_H---•-------� ----g...-- Address _ �D-9r11L--------=--- ------------------•-•---------------------------------------------------------------------------------................... .* - Ho. �-126p Contractor's Name...----Delta Septjc Tank -Service,, 14 IT1C. � Phone ---- y Installation will serve: Residence:U Apartment House ❑ Commercial ❑ Frailer Court ❑ Motel ❑ Other ❑ Number of living units i.-1'-_ Number of bedrooms _-z_-. Number of baths Z----- Lot size ____50__x--- 00___ _-_-_-_ _ Wafer Supply: Public system [jj Community system ❑ Private ❑ Depth to Water Table 35--- ft. i Character of soil to a depth of 3 feet: Sand [-] Gravel [I Sandy Loam El Clay Loam E] Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,dote---------- ---------) No [?[ New Construction: Yes E] No ❑ FHA/VA: Yes ❑ No E TYPE OF INSTALLATION AND SPECIFICATIONS: -(No septic tank or cesspool permif+ed if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----xk.Q-------Distance from foundation_ ------.Matterial__-----._C--.---Cf;mgrit-__-_______ F 4f e [ No. of compartments-----------2--------- --- - ------------- Liquid depth-----32----------------CapautY------gO{a---••--- Dis Disposal Field: Distance from nearest well_ --Ali+:---_Distance from' foundation__.._�c:0....---.Distance to nearest lot_l�i te----- ---------- LA p Number of lines'�--------------�.----------------Len Length of each line ------------- of trench--_.---_-_L_irt• ' � g 1811 �,� Type of filter material---_--X'Qek._.--_Depth of filter material___-----__-_- -----._Total length----------------l--_._.:.____---_------ Seepage'Pit: Distance to near st well P-------___Distance from foundation__A�1�._.Dis t�nce to nearest loj�ipe------ P---. F `, max, Number of•pits---=---= ----------Lining material-----T'oCk------Size: Diameter----3�-____.-----Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------.------Lining material_--_---__.---------_----_--___-----. ❑ Size: Diameter----------------------------------------Depth-----------`-------------------------- -------------Liquid Capacity-------------------•--------gals. Priv Distance from nearest well-------------------------------------------------Distance from nearest build':ng--------.-----------.----------------------- 0 ❑ Distance to nearest lot line------ ---------------------------------------- -------------•----------------------------- •-------------------------------------------- Remodeling and/or repairing (describe);---------------new- f31, --_ St m-.. 07-._674 !gg,,oTlE3_�"bed'-rooM ho1A _ _ i -----------•-----•--------------=--------=----•--•-------------------------------•---------•-- _.-----"-"--------------------------------------------------------------- - ------- ---------------------------- --------- ------------------t--------------------------------------%--------•-------------......---------------------------•,-------------"-------------------------------`--------------------- 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. (Signed)----------------- a---Sept1__Tgnk...Serv.iee_,----Inc.__#-------------------------------------------------------(Owner and/or Contractor) P_erry___Q..... grthan-------------------------------------------------------------------------(Title)------------8n•---Mir--------- ------ (Plot plan, showing siie of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse side). l FOR-DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY__ .._r-- --�-_ - �� ` DATE__ -` = ----------------- -- ------------------- REVIEWED BY----------- --- DATE r- cY - DATE. t BUILDING PERMIT ISSUED_- .��-v t =-- ^- Alterations and/or recommendations. -- ? ,mss (ill ✓. �j 7 ------ � •- ---- p a 1�------------- -------r• �--------- - - -� ----- <- J , 7�-T/% r — �`� r .� - FINAL 'INSPECTION BY: . . _ - -' Daae-� --------------- --- ------------------------------------------- ---------------- SAN JOAQU1N 1OCAL HEALTH DISTRICT 130 South American Street I 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California -Manteca,California Tracy,California E8.9 REV15EP 9-s9 r.r.co,ZM 6-.0 s L 1