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FOR OFFICE USE: ,t -------------------------------------------------------- ___ APPLICATION FOR�`SANITATION PERMIT Permit No. .... (Complete in Duplicate) f c _ __________________________________________________"' Date Issued __ This Permit Ex ires 1 Year From Date Issued ____ Applica+ion 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-------------944south---Gol-den...gaate--------------------------------- Owner's Name C Or18EL a Vi F YIdO--------r----------------------------------------------- -----•-------------------- Phone.-•Hq'--4-4.637 Address--------------------9-44 south Golden Gate ` --------•---_----------------•---••--•- ------... --....-------------•-••---------...--••------------..._.-._....------•------•-----------------....... Contractor's Name---------Delta--Septic Tank Service,,)-- Ince Phone----49'--A'199a-- Installation will serve: Residence [a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___- _ Number of bedrooms _4--- Number of baths __--_ Lot size J __x---11fl--------------------------_________ , Water Supply: Public system [?3 Community system ❑ Private ❑ Depth to Water Table -41_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: (if.yes,date--------------------) No ® New Construction: Yes [?F No ❑ FHA/VA: Yes ❑ No [3 . 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 ____-._____-_____________-__________._____-___-- etlrig No. of compartments Size ---------- ------------Liquid depth Capacity Disposal Field: Distance from nearest well-1-0.0-------Distance from foundation____1_C?_'---------Distance to nearest lot line__�S__'_______ Number of lines___._____I-------------------------Length of each line-------I_C�`______-_______.Width of trench----Z__ :"-________-_-____--- 4 Type of.filter material-_-_ Depth of filter material-------11............Total length--------1_-01-------------_•..--_.___.- –� Seepage Pit: Distance to nearest well-----nP___.____-_Distance from foundation---19.'.........Distance to nearest lot liine___ ____________ ® Number of pits.________�.______Lining material----Z'45Zk-------Size: Diameter___•_33 _______-Depth_.__25_---m ______ Cesspool: Distance-from nearest well------------_----Distance from foundation---------------------Lining material------------------------------------- 6A ❑ Size: Diameter---------:----------------------- ---Depth-------------_-------------- ------------------Liquid Capacity------------------------_--gals. Privy: Distance-.from nearest well-------------------------------------------------- from nearest building-._____-_________-_----...------------- I ❑ Distance,to nearest lot line--.--'---------'---------------------------- --•-----------•---------------- Remodeling and/or repairing (describe):____-add3.ngFilter-Bed--:tO---exlsting_pyg8 _p ............ . = ------------------------------------------------------------------- -_ W -- ----------------------------------------------------------------------------------••--------_...----------------.--------------------------------------------------------------------------------- I.hereby certify that l 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 S 1110 'lank Services _ I1C..t_________ Owner and/or Contractor) (Signed) --------------------------------- { ) BY:---------------------- -error Q* Warthan----------°----------------------------•---•-------------------(Title)-----Qen Mgrs---- (Plot plan, showing size of lof, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ------- DATE-�s --- 4' S?------------------ REVIEWED BY--•--------------------- al - DATE------------------------- BUILDING PERM lT'ISSUED -' ------------`-------------------------------------------- ------ DATE:--------------------------•----------- -- ------------------ Alteration's and/or recommendations... '--•----------------- }" = = :_ _:.... � ?� - - - - --------Q_,.4------------------------ � .� y---�sz�.-:ac�_e.d tit Z -r----------------------------------------------------------------------------------------------------------------------------- --------- ----------- - FINAL INSPECTION BY:J0......��S__5----------------------------------- Date-- _.i - ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Stroet Stockton,California Lodi,California Manteca,California Tracy,California E9.9 REVIBEo a-SB F.P.0 O.XM 6.00