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APPLICATION FORv..ANITATION PERMIT Permit No. ... .......j-7--- N. (Complete in Duplicate) — - Date Issued .----- 4 / 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-----------At. 2, Box 195, Lodi,- Calif. CZ5t--2SD—SS f - ----------------------------------- Owner's Name----------JOY]---- &I1C-1 ------- ] fBf;rit - _ w.-.--,: ., .: Phone ��n 88200 2t 0 x ------------------------- ' ------------------------ -----------•-------------.----------- Address Rt. i r fO95a_-Lodi Contractor's Name--------------DZ &--3eY] C--Tank 83"VCe1H --- Tl(+• . 3.»'7z _-__` Phone �.e- -- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i I Number of living units: '1 - Number of bedrolms _3-_,_ Number of baths -----1_ Lof size -3---wzro�IL------------ ----------------------- � Water Supply: Public system F❑ Community system ❑ Private ® Depth to Water {able -3-5-_--'ft. Charactei of soil to a depth of 3 deet: Sand E] Gravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe EA: Hardpan Ej Previous Application Made: Yes N No E] New Construction; Yes ® No f-1PHA%VA: Yes E] No TYPE OF, INSTALLATION AND SPECIFICATIONS: R r (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) i+ Septic Tank: Distance from nearest well-----------------Distance from foundation-----------_-+-----Material--_ � __._______.___�____-_. �i6ting No. of co'pa;tments--------------------------Size--------------------------------Liquid depkth-------•------------------Capacity-------------- f------- t ' am nearest well.-S�----------Distance from foundation__/5_'___�-__'Distance to nearest to line--$-'-------_ N Dis l field:AFVg Distance fi lines----___-�- -.------. -- ---Length of each line__�o---------------!-_--.Width of trench---.2 _-:--------..-- ------ p �, 'sting Number of N Type of filter material ___Depth of filter material---�_ �-_____--_-Total length----„ Seepage Pit: Distance to n crest well----10a __r-D:stan+e from foundation-- PX-�_.Dist��ce to nearest lot line__Mj%9 fi ® Number of pits. ____-------------Lining materialir-�ok--------__.Size: Diameter-_--_33- ..---:Depth_._2.rt—f—t-:-#--- ,- - Cesspool: Disfiance from. nearest well-----------------Distance from foundation---------- ----.Lining material__._____---�5"------ !�" -- Size: Diameter---- - -- --- Depth --------------------------------------------------Li uid Ca acit,N ( gals. Privy: Distance rem nearest well-------------------------------------------------Distance from nearest building------ _----.----------------:--------. ❑ 1 Distance to nearest lot line----------------- ------ I----------------------- "' ""�"" ---------I------------ Remodeling:and/or repairing (describe)----- - dd 218 aP gto----exle�-ing---Byi31e11t_.. I -•----------------------------------------------------------------------- ----------- ----------------------------------------- ---------------?__-_.-___--.-------.---------------- I ----_----_---- ..-------------------------------_------------------------------------------------------------------------------------------------------------I-------------- I hey 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--Septic--_Tatlk._.S_ery .Ce,-1-TC-`----------------------------------------------------(Owner and/or. Contractor) I Perry- Warthan ....-- —(Title Gen.---Mg rBy=-- --------------- .. �; ------------------------------------------ --( i } (Plot plan showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). v.• FOR DEPARTMENT USE ONLY ; ¢ ------ DATE--- -- APPLICATION ACCEPTED BY-------•-----------------------r ---.- _- -- ------ � -------------- REVIEWED � � - ------------ REVIEWEDBY------------------------------------------------------------ - --------------- DATE L... _ -------------- BUILDING PERMIT ISSUED-------------------------------------- _� ti rDATE ------ . .1 BUILDING and/or recommendations:-------------------------------- -------------------------------------------------------------=------------------------------ Ir t , y r - -----------t-------------------------------------------------------------- ---------------------------------------------------_---------------------------------------------------------------------------------'------ � r FINAL INSPECTION BY: / % -------------------------- Date---- - &--- --------------------------------------------- SAN --------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California I ES-9-2M , Revised 1-57 F,P.CO.