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APPLICATION FOS SANITATION PERMIT Permit No. (Complete in Duplicate) !� Date Issued _---.��-�� Applica-lion is hereby made to the Sari 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----- -----RX------First house East oP Holly Drive on---G---r---a---n---t---l---i:--n- e Rd. r T------ - on North side, racy Owner's Name-- � R»------•Ql-ark---------------------------------------------------- - ---- ------- ----- -- --------- Phone---Te 5--1537 .-- ,--•Q. Box-3 Tracy Address P B ---------------------------•---------_------------------------------------------------------------------------- Conti•actor's Name______ elU_._Se_ptic_--Tank Service_,__--Inc. PhoneH©.�..- -269----- ' Installation will serve:t Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1.-.- Number of bedrooms ----?_ Number of baths!------ Lot size --------------------------------- Water ---- --_ - Water Supply: Public-system ❑ Community system ElPrivate ® Depth to Water Table 16__ ft. Character of soil fo a depth of 3 feet:! Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[3: Hardpan ❑ Previous Application Made: Yes ❑ No Ej New Construction: Yes M No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance- from nearest well --------------Distance from foundation--------------------Material-----------.---.--.---.----.------------------`. Exist[�Iag No. of compartments-------------------------Size--------------------------------Liquid depth---------- -------------Capacity------------------------ Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- Exist g Number of lines----------------------------- - ---Length of each line:-----------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material---------------__-----Total length_--.------------------_-----_---------.- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---_--_---_-__ ® Number of pits----------------------Lining material------------------------Size: Diameter-------------------------Depth-..--..-------.---__------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-- ----_.---_-..-.--.----------__---_. ❑ Size: Diameter----------------------- ------Depth-------------------------------------- .-----------Liquid Capacity---------------------------gals. Privy: Distance from nearest weft---_------------------------- ------------------Distance from nearest building-----..----------------------------------- g ❑ Distance to nearest lot line------------------------ ----- - - - -----------------------------------------..---------------•----------------------- •• Addin two x480x6' verticals to existing Remodeling and/or repainng (describe}: b ---- -------------------------------•-------•---•----------------------------••------- septic...syetem---------�=�--------------- --- - - rf f k'. - ii ------------------------------------- ---------------------------•-----------------------------------------------------------------------------------------------•--------•-----••------------------------------------------- - T ------------------------------•------- --------- .......------------------------�---------------------------------- I hereby certify that "'Dave prepared 1his:appPcafion and Waf the work will be done in accordance with San Joaquin County-' ordinances,"Stafe.la wand rules and regulations of the San Joaquin Local Health District. Deltaepc Tank Servic�el, Inc. Owner and or Contractor (Signed)•--- •-- ----------•---------- ----------- - -------------------------------------- - -------------------- -----( i / ) ry Plot Ian. showing size of lot, ovation ofW&rth- --------------------------- -------=-----------_ (Title)..0 eI7 M�,�`•--------------•----------------------, .. - Perry - ' system in relation to wells, buildin s, etc., can be laced on reverse side).� �. { P y ing, r: p v > _s FOR DEPARTMENT USE ONLY( lasU APPLICATION ACCEPTED BY \' r - DATE--------------- = c .'"-"s`S. a -,w • -------------- ----------------- REVIEWEDBY----- --------------:----- ----------------------- -- - ------ ------------ --- --- # BUILDING PERMIT ISSUED.--- •-- -•--- - ---------- - „�_�- �--------11---------- DATE.------h-- --� � -- Alterations and/or recommendations. ---------------------------------- --------------—............... -...----- •------•-----•---•-----•----.._....-...._-•-------------------- 1 x ------------------------- ...------------------------------------ ----------- -------------------•--•----•------••----' ------\1........................... __ - ------ ---------------------- - ----°-- -- = PPPPPP -=----- ------------------------ --- - - -- %� ,• ----------------- --------- ---• - ----------------------•------ - ------------. ---- --- ----- --•---"`-�`------ f- - -- .. - ---------------------------------------- ---- ---•-------•-----PPPPPP-PPPPPP PPPPPP- ----------------------------- G� f FINAL INSPECTION' BY: ._ 3�'� 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 x EE--9-2M 145446 ATWOOD 12-54