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FOR OFFICE USE: �. /� � �• s APPLICATION FOR SANITATION PERMIT Permit No. _.________ . _.. (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........3-760---W..._-$.0xi.4ra_,_..B.t0_ckton,....11a,1if..-------_----------_------------------------------------- Owner's Name--------- 'Ux.'Ile..aSa__Le-ori8---susamena_o -------------------------------_ -------- ........PhoneHai ....4-. .468------- ` Address---------------------Ab Above I Contractor`s Name-----------H_el'L&._jS_e ?_t_10---Tank__Herv.'Lca lue-*---------------------------------------- PhoneHo......3m1.2-69------ Installation will serve: Residence IN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .._1. Number of bedrooms ---- Number of baths _1___ Lot size _5_9__'X6_0_'________________________________________ Water Supply.• Publics stem Community system El Private Depth to Water Table _ ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe[Z Hardpan ❑ Previous Application Made: (If yes,date____________________) No Kj New Construction: Yes [2 No ❑ FHA/VA: Yes ❑ No J i TYPE OF INSTALLATION AND SPECIFICATIONS:, (No septic tank or cesspool permi#ea+if-public sewer is available within 200 feet.) �I Septic Tank: D3 stance from nearest well_________________Distance from foundation-------------------Material--------------------------.----------.__________- Existnig No. of compartments------- ------.----Size.--------------------------k----Liquid depth-------------------- Capacity----__......... Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-_______________ Exist Number of lines-----------------------------------Length of each line------_-----------_-_-----_-.Width of trench..---------------------------------- Type of filter material_________________________Depth of filter ma#erial_---------------------Total length_____________-_-___________.__--____-____ Seepage Pit: Distance to nearest well----N-01le---___Distance from foun.da on,,.rZ Q-1_-___-Distance to nearest lot line----3_=____.-_ it KI Number of pits-------Z------------Lining material_____Ro-Ck-----Size: Diameter - - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_______________________--_________.-. Q ❑ Size: Diameter---------------------------------•----Depth----------------------------------------------------Liquid Capacity-..---------- •----------•-gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot line------------ ---- ------- ------....L ------ I •-------•---------•----------------------------------------- Remodeling and/or repairing (describe): __A3L1�Ti� F�Zt,@2'-bei-•-�O_---exist_1Si$___.Sy_eteM----------------------------------------- -----------------------------------------------------•--------------------------------•-------•----------------------------------------------------------------------------------------------------------------------------- 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. Delta Septic Tank Service. !n ,------_--__-rE Owner and/or Contractor (Signed) ------------------------ ------------------- ------ --•--,-- T----[ ,/ l PV. erry --�-- __--------(Title)--._ en gx. -----f ---------- -- -------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1A FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -------------------------------------------- r ------- DATE---- `J AREVITE EWED BY `= --------- ----------------- ---------------- --•--------------------------•------------- BUILDING PERMIT ISSUED.........I------. -------------------------------------- DATE_______________________ ___ Alterations and/or reco mendations_______ __ ____________------___----------_ ----- zi. ----------------------------------------------------------------- -------------------•--- ---------- •-•-••------------•--•------------------•------------------------- -------- ---------------- FINAL INSPECTION BY:..---- ¢-`fes------------ Date--------- � w USAN JOAp IN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Es•9 REvis Qq 6.69 F.P,CC.7M 6.60