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FOR OFFICE USE: r*,\ moi.z__ ---------------------------- ------------------- ------ APPLICATION FOR SANITATION PERMIT Permit No. .......:.... omplete in Duplicate) [C . /� ---..--------------_-------------------------_________.___ This Permit Expires 1 Year From Date Issued Date Issued _____ ___________ 1 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. I JOB ADDRESS AND LOCATION--------'426--- _.....Har_v_ey,-._5_tA-ckton.....CaJL1f......_--------------------------•-------------------------------- Owner's Name------------- -.----------------------------------------------------------------------------------------- Phone..TiQa----5m7Q.72----- Address--------------------------Abo..V e-...----._....-•---------- ---- ---••-•----------------------- C Contractor's Name-----Deltta_- sep c__Tank__Sex'7leea InC--------------- -- •------ Phone•••--HP-+----3--126Q- Installation will serve: Residence:E] Apartment House-❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._1___ Number of bedrooms A_ Number of baths ---1. Lot size .,%?-_5' 21 !-___.._...__ Water Supply: Public system ❑ Community system ❑ Private FK1 Depth to Water Table35___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: (If yes,dote-----------_--------) No [2 New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No Il 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--50.1--------Distance from foundation-_10-1__--_.Mate tial-__.�`.HL1fr7��'+_______________________._... f;] No. of compartments-----------a____-_--_-_Size__-.x4___$G4__X4.-Liquid depth_____3�.___.._____._.Capacity__._8QQ__$a1 Disposal Field: Distance from nearest well__50---------Distance from foundation-; .Q_t__-._.....Distance to nearest lot line______5.�_..... KI Number of lines-----------]----------------------Length of each line.......... _D r[e..._____.Width of trench__ _-.21__________________---_ Type of filter material_____--_-�o_0�L,---Depth of filter material_____15._.........Total length_______ _ r_.I.________-------------- e Seepage Pit: Distance to nearest well---1q9_;--------Distance from foundation-----10 -------Dist?nce to nearest lot line__ _____ Number of pits---------3-_---------Lining material--------x'pCk---Size: Dia meter----33______-------Depth___25_____Ma��___.. Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material--------------- Size: Diameter--------------------------------------Depth---•------------------ ------Liquid Capacity----•----------------------gals. Privy: Distance from nearest well----_--- --------------------------------- from nearest building--_--___-_-___.___________.____.-_.--. ❑ Distance to nearest lot line---------------- --------- ------------------------------------•----•--------------------------------•-------------------------------------- Remodeling and/or repairing (describe):---------Ins_tallIng y ------------------------------------------•-- ----------------------•-------------•-----•------------------------•--.......-------------------•---------------------••---------------•-••------------•--------------------- ------------------------------ ----------------•-------------------------------------------------•---------•--------------------------•------•------------------------------------------------••---------------------- 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 Septto Tank Service, Inc. (Owner and/or Contractor (Signed) --------------------------------------------------------------- By:--------Perry--- f-rthan--------------------------------------------------------------------------------•----(Title)_Gen. Ngre------------------------------------- (Plot plan, showing size of lot, location o`1 system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - ------ ��-�-f --- ---------------•--•---------------------------- DATE------------- - --- --------- REVIEWED BY---------------------------------- ------- -------------------------------------------------------------------------- DATE---•------- • , ------------------------ BUILDINGPERMIT ISSUED----------- ---------------•-•------------------------------------------------------ ------ DATE------------------------------------------------------------- Alterationsand/or recommendations:--------------------------------------------------------------------------------------..---------------------------------------------------------------------- ..----------------------- ---------------------------- ::-- --- - -------------•------ --------------------- •-------------- ---------------------------•-••-----•------------------------------------------------- -------------------------------- ----------- ----------- --------- --- ----•------------------------------ •-----•----------------•----------- ----------- ------ -------- ------ --- -•--•-------- 6 FINALINSPECTION BY:-- --------- — ------------------ ------- Date-------- -------------- ----• --- -- ----------------x--------.-.-----x-•-------- r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stre t 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California t Lod[,California Manteca,California Tracy,California ES-9 REVI6E0 5-59 F.P.CM.3M 6.60 --