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FOR OFFICE USE: - -- APPLICATION FOK SANITATION PERMIT Permit No. . -<--- --------- - --------------,i--- (Complete in Duplicate) g� This Permit Expires 1 Year From Date Issued Date issued .-------- - r .. 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 ini+compliance with County Ordinance No. 549_ . JOB ADDRESS AND LOCATION_____-_M---West Howard- St, S. of Charter Way. and IF. of. Owner's Name.___Fructgoso_•Y._&__Date Elle S. +`Stockton St. .� ti ;:� ------ -- ----- Phone. - - --- -- HO. r Address x - C??c �'w 1 oC11 --------------- -- -- --- - - --- ------------- Installation will ------ ----- - ------te a, Delta se tic Tank Service Phone..-----r' a ,1 Contractor's Name------- --- -- _= Installation will serve: Residence A artmenf House Commercial Ej Trailer Court 0 Motel E Ely 3&A Dth6_�_I Number of living units: ___1__ Number of bedrooms .--2-- Number of. baths_ ____1_ Lot size _______- Water Supply: Public sstem y: Puy Z] Community system ❑ Private ❑ Depth to Water Table 3.5__. ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam:0 Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: (If yes,date_____ ________) No ❑ New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No N TYPE OF INSTALLATION;AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer isavailable within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation___--_-______-_._-_.Material Exerting No. of icompartments--- ----------------------Size----------------------•-------Liquid , depth--------------------------Capacity-----------••--------- stance from p l 'l nearest well --------- --- - foundation -- ---.Distance to nearest lot line________....____EXtptin� Numbeof Ines - -- -Length of each line -- ------- -.Width of trench..--------- Type of,filter material-------------=-------- ---Depth of filter material--------------_--_---.Total length-----------------:-------_-- iI -------- Seepage Pit: Distance to nearestwell______APO --------Distance from foundation__j1. 19_.DistarlFe to nearest to tline____5 gym. Number of pits--.______�-______-__-Lining material._ra_Ck_____--_Size: Diameter-_.___-��__-_-.____Depth__-2___.___-m��_------ �} 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):_____--:_&dd;.I3g___,9e.e_p.e, e___�-I-t _(Fil er!-H-ftd). O �X1 8th n S BteM ` --•-----------------------------------------------------------------------------------------•----------•-------------------•-----------•----------••----------------------------------------- -------------------------------------------•---------------------•-=------•-----•-----------------•----------- - I i. ----------- 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. i } (Signed)-------jP1ta__septic riRTlk sex'V. zxlG j. ------(Owner and/or Contractor) Byc: P. xry. +r? .._ ar h -----------------:---------------------•-----------------------------------(TiflG)__G_e_n_.___.Mg_r_6------------ ---------------- ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 ° FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ,BY C�= ----------------------------------------- DATE...---- .... rr REVIEWED BY ------' --------------------------------------- DATE. BUILDING PERMIT ISSUED"------------------------------------------------------------- ------ DATE------------ •---- Alterations and/or recom nd ions---------------------------- ._ 6 Q ------------- -------- , ---- ------------------------------------------------------------------ ---------- --------------------- -- "--- ---------- FINAL INSPECTION BY:------- ---. _ � ---------------- Date-Y -- --------- ---------- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT k 130 South American Street 300 West Oak Street 134 Sycamore Street 405 West 9th Street Stockton,California lodl,California Manteca,California Tracy,California E6.9 REVI990 6.54 F.P.00.2M 6.60