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APPLICATION FOR W ITATION PERMIT Permit No..- ac., ._ (Complete in D plicate) Date Issued This Permit Expires 1 Year From 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. 8 $ t Horner JOB ADDRESS AND LOCATION Eaa- ---------------------------------------------------------------------------- --------------- .._.---------------- Owner's Name ---------- Vida3andJane MOntalvo HO, 4-6240 _____---------------------------------------- Phone -----.-------------------------- Address -- - Ad d ress----------------------3_83a--vL-g-t---Ho rnBr -Contractor's Name -------- Del -t -SI--- g_ep_�d Tank S-ErV......... inO.---'---------------------------------------- ------ Phone.----.HO� 3-7727 - ---------------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -2---- Number of bedrooms --- 4- Number of baths __2--. Lot size ----- _-19Q-_--_x__1©Q------------------------- Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table -45_. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Acioben Hardpan ❑ Previous Application Made: Yes ❑ No [)c New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 11 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �.. Septic Tank: Distance from nearest well ----------------- from foundation-- ---------------- Material___________._________..___._____-_ Ex"ting No. of compartments -------------------------- Size-- -------------------------- •---Liquid depth -------------------------- Capacity ----------------------- Disposal Field: Distance from nearest well- _ Distance from foundation -------------------- Distance to nearest lot line ----------------- pd Exiting Number of lines-------------------------- -------- Length of each line ----------------------------..Width of trench----------------------------------- (N Type of filter material_________________________ Depth of filter material ----------------------- Total length ---------------------------------------- ._ Seepage Pit: Distance to nearest well_____no----------- Distance from foundation___ 10 -_______.Distance to nearest lot line__. 1_______._ IN Number of pits___________ _______ Lining material ------- r©4 Size: Diameter__-__- _ __. p 2 max. 9Dept ---------- 1 Cesspool: Distance from nearest well ----------------- Distance from foundation -------------------- Lining material__.__._____________._______._________. ❑ Size: Diameter -------------------------------------- Depth ---------------------------------------------------- Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well --------------------------------- _--------------- Distance from nearest building __._______.__.________________.._____._._. ❑ Distance to nearest lot line-------- --------- ------------------------------------------------------------------------------------- ----------------------------------- Remodeling and/or repairing (describe):__ -__Adding .... eepage-__pit... to existing system ------------------------------------------- ---------- --------------------------------------------------------------- ------------------- ------------------------------------------------------------------------------------------------------------ --------------------- - - - - --- - - 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. (Signed}!�e1taSepticTank Sere.r__-_Inc, --- ---------------------------- --------- (Owner and/or Contractor) By: ------- P Qx17y-- Q= -[far_than----------------------------------------------------------------------------- (Title) Gen. Sr`----------------- -- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE ------ 1�----fS�f�---0---------------------- -- - REVIEWED BY ----------------------------- --- --- DATE----- -------------•--------------- BUILDING PERMIT ISSUED --------------------- DATE -- --------------------------------------------- Alter tions nd/or recommendations:------ >��-- -- ----- _--"�--- � ,------------------------------ ------ . _ _==r== _ _-- __ _=__ -_____ ___ -----------------______________________ -- - - - --- FINAL INSPECTION BY:.-------- ------------------ Date---------. r/ 4 --------------- 130 ------------- 130 South American Street Stockton, California ES -9-2M Revised V59 F.P.Co. SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street Lodi, California Manteca, California 814 North "C" Street Tracy, California