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IVQR&3FFICE USE: -------------- e APPLICATION FOV ANITATION PERMIT Permit No. ... . ------- ------------------------------------------------- (Complete in Duplicatel /6 '�--------------- This Permit Expires 1 Year-From Date Issued Date Issued .--_--/ d. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This-applications is.made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------Route---i_,......Box_880,+ Tr�cy� CaZSf, corner of McArthur and Owner's Name--.-.-Tpaoy--Pub1c 'Gemter Schulte Rd , --------------------- -- --=--.Phone T.1?t.... '3 g Address------------------ Contractor's Name----------- ------------------------------------- 269 Ho•__.. ._ _ Phone -�I ----• Installation will serve:, Residence ❑{ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of.living units: .-_ -_ Number of bedrooms .-1_-. Number of baths I...... Lot size Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table 25--_ ft, Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ® No ❑ PHA/VA: Yes ❑ No ❑ 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------------------Distance from foundation-------------------Material_--_-_---.---_____-__-__-_-.-__-__-..-._-____-.. Existing No. of compartments--------------------------Size.----- ----•Liquid depth----------- ---- Capacity., I --------------------- Disposal Field: Distance from nearest well------------------Distance from foundation---_ _.__---.Distance to nearest lot line--------.--.__... 4ciSting Number'of lines`--------- 4-----------------------Length of each line-------.-----_--__-----------.Width of trench . xr:mateiial.. Depth of filter material ---.Total length e of filte,M. �.�, ,ray. ,xf _ ------------------------------------------ `nearest well----J.-QQ'.F_.--Distance from foundation_I� P--_-_.Distance to nearest lot line_-- P_-----_ Seepage Pit: Dis#ance'�;t�� KI Number of pits.-:---�-------------Lining material_-T`Q_Q�L-_--___-Size: Diameter-39....... Depth-----10' •---- Cesspool: Distance"from nearest well----------------Distance from foundation--------------------Lining mate ------_-•rial----.---------_ j' It ❑ Size: Diameter Depth ---------------Liquid Capacity----------------------------gals, E Privy:, Distance from inearest well------------------------_ g____--- --.-.---__-.-..-Distance from nearest building �Q � ❑ ��:` Distance toynearest lot line ------------ ---------------- -------------------------•------•------------ ----------•-----• •---•--------------•------------- ------- � .. Remodeling and/or repairing (describe):--_-__aCf� ,IIP,__ _ _�� Q•�f't,�___F-flt8r«•$ea tp exi $i;ing septic -------------------------------------------------------------------------------------------------------------------------- -- -------•----•-----------------•-- -•------------•-- ------ ---------------------------------------------------------•----•--------------•- ----------------- --- -•------------------------------------------------------•-------..._.-.......•---------------------------- 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)-------Del_ > -_S�ptiC--Tank_ Service, Inc. , (Owner and/or Contractor) ' ---------------------------------- By= P ry Q.,�.._[�I than---- ----- ------ -- •-- ------- ••--------(Title)----Gen. Mgr.-------------- -- (Plot plan, showing size of lot, locations of system in relation to wells, buildings, etc., can be placed on reverse side). 3 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•------------------------------------- - DATE- ---------------- REVIEWED BY -------------------------•------------ - -- ---------------- DATE----------- � BUILDING PERMIT ISSUED---------------------------------------------------------- -= DAT Alterations and/or recommendations---------_-._-_..-_. - ------- ------------- - =-----------••-------•- ---"--------------------•-------••----------- -------------------------- ----------------------------------•--------------------- -------- ----------------•-------•---------------- FINAL INSPECTION BY: '------- Dates- r--�.--" . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteco,California Tracy,California E9-9 gEVI6ED 8-59 r.P.0 p.2M 6•60