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Nr oor APPLICATION FOk.:.aANITATION PERMIT Permit No. ..f�.L}.._Q._!._-. (Complete in Duplicate) 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---------- - --- ---Zth--Sty r_ _ --- - ----------- ----------------------- -•------•----------------------------••--------------------- Owner's Name------•_-AS?n-914--F,---- # _- Ya--lndreonPhone------ ----------------- ---5-469-1-- Address--------------- -4691--Address-------------------133---E'---7WAt.--s Contractor's Name------_--__- a .'ta Se_'�q,__Tank Service, Inc. Ho. 3-7727 ------ --------------------------------------•--- Phone---- Installation will serve: Residence [Z Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I"-_ Number of bedrooms __z_- Number of baths ---1-- Lot size ------ 5---3C 16Q. Water Supply: Public system EX Community system ❑ Private ❑ 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 ® New Construction: YesX] No ❑ FHA/VA: Yes ❑ No EX 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 ExUling No. of compartments--------------------------Size-----------------------•-------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest wefl-----------_-_-Distance from foundation-._----------------Distance to nearest lot line--------__---.--- Exining Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------- -------Depth of filter material----------------------- length--------.--------:---------------------_- Seepage Pit: Distance to nearest well---110-------------Distance from foundation----- -ae-......Distsince to nearest lot line-52------------ Ex Number of pits--------1----------Lining material--------X!0 k_..Size: Diameter----3.3-------- ------Depth-----2�------akr�7Cd------ W 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-_.-...--.--__----.----._---..-------.- ❑ Distance to nearest lot line Remodeling and/or repairing fdescribe):------Adding---eeepag.e...plt...(F-ilter-Beds to exp eting system ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- ------------------ ---------------------------------------------------------------------•----------------------------------------------s------------------- -------------------- •--------------------------------- -- 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)---------Delta... ept1 c---T-;Wk--w�feY'Y1Ce,-__InC,_ _ (Owner and/or Contractor) ----------------- ------- ------------------------ By:-----------Perry-Yarthan Title Gen.-..M r. ---------------------------------------------------------- - [ ] - ------- - ------------ (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--------- ------------------ ------ --- ------------ DATE REVIEWED BY --------- ---------- = DATE a BUILDING PERMIT ISSUED- --- --•----------- — DATE. Alterations and/or ecommendations:.------ ------------------------- -- ---------------------------------------- ,,ccam� -------------------------------------------••-------------••------------------------------------------------- ---------- --------- ------------------- ------.----- L� - ---------- ---- - :3 a ------ -----.---1�-- --------------------------------------------------- FINAL JNSPECTlO Date------ - 1p . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Streat 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California -* - ES-9-2M Revised 8-'59 F.P.Co.