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x pyw�S � APPLICATION FO{;gNITATION PERMIT Permit No. (Complete in Duplicate) Date issued ___-.--•---- --__- Applica-lion is hereby:mod& to the San Joaquin Local Health District for a permit to construct and install the wor herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION __2060 E. 6th St. ---------------- --- - ----------•----- Owner's ame--------------Alt--.v�•Y'110I1 --•--•---------•----------•------•--- ------•-----•--•---------'=-•�r' --------------------------------------- ------- Phone_HO• 577464 -----------•--------•---------------•--------- = Ho�._ Contractor's Name---------------Delta Septio Tank 5erVice Inc. ----------------- ---------•-----------------------------------'---------------------------------------------•----- 3-1269 Installation will serve: Residence KI Apartment House ❑ Commercial Phone__ _________________---_ Number of livingunits: ❑ Trailer Court ❑ Motel ❑ Other ❑ l-.___ Number of bedrooms 2----- Number of baths 1____ Lot size _._____-.SQ__x 1,SO Water Supply: Public system -------------------•----__-___ ' Y [X Community system ❑ Private ❑ Depth to Water Table -_#Q {{- Character of soil to a depth of 3 feet: Sand p Gravel p Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8 Hardpan Previous Application Made: Yes fi E]❑k No [9 New Construction: Yes IC No [] . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ExitiSeptic Tank: Distance from nearest well---------------_Distance from,foundation--------------------Material------- ----------------------------------------- Disposal Field: Distance-from ng No. of compartments-------------- ------- --Size--•-------_-_-- ------Liquid d - epth---------- --------------Capacity---------------------- Exi�i� Numbeer of linn es-----------------mnearest well-----------------Distance from foundation--------------------Distance to nearest lot line Type of filter ma - ---------------- -Length of each line____--�---_---- ------- -Width of trench_ ------------------- terial --_---Depth of filter material---------------- ------Total length------------•---------- -------------__--- Seepage Pit: Distance to nearest well------q------ Distance from foundation___J9 t i Dist nce to nearest lot�i3el5-------- Q Number of pits---- Lining material--rook 3a1- - - ----- --------Size: Diameter- ------------- ------Depth--- ------ ------------ - m Cesspool: Distance from nearest well-----------------Distance from foundation-_-___-_--------__-,Lining material------ V l ❑ Size: Diameter -t----------- -------------------Depth------------------------- - ----- -------------- . Liquid Capacity- --------------------------gals. Privy: Distance from nearest well_--------------_ Distance to nearest lot .............................Distance from nearest building• ❑ line__--_--------------- ---- ------------------------------------------- Remodeling and/or repairing (describe __________Addin e P------------ _ _-_s _e _age__P t_.toexis ting system --- - ---•--- --------------- --------------------------•------- -------------------------•------------•---••-•--•-------------------------- ---- -------------- I hereby certify that I have prepared this application and +hat 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) ) ti ---------------------------------------------------------(Owner and/or Contractor) By:-------------------------- Perry--drthan. Gen. I (Title) -----•----- Mgr• (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-----=------------- , - ------------------- 6S -----•------------ �aBUiLDING PERMIT ISSUED ---------------- -------------------------------------------- DATE -----------•-------------- ----------------------- - _______ DATE Alterations and/or recommendations: ------ ------------i ------•------•------------------- ---------- Dat --------------------- ------------------------- FiNAL INSPECTION ' /2 s Ie r --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 874 North "C" Street Stockton, California - Lodi, California Manteca, Celifornie Tracy, California E5---9-2M 745446 grw000 12-54