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A� " to APPLICATION FOR SAi,.ATION PERMIT Permit No. _z�Z2_._ (Complete in Duplicate) ' 1061 Date Issued _-!l__'y/-sow Application is hereby made to the San Joaquin Local Health District fora Permit tconstruct This application is made in compliance with County Ordinance No. 549, p and install the wort herein described. JOB ADDRESS AND LOCATION_--------------2�.---9quth_ or Angeles-_ Stk!n �.�.�. ,-------- Owner's Name----------L �L�tT1._��,.�� ------------------------------------------------------------ --------------------- ------- .......... Phone-- HQ-# 3'"d'j20 1 Address--------------•-------19--°g} LoB �n�e1�8 4 .- (;&; . --Contractor's -- Name--------pelta-_Septj c Tank SerYice, - Inc. ---•-------------- K 3 3 2b9 --- ------------------- ------------------------- Phone----------'-- -----�-----• ------ Installation will serve: Residence ® Apartment House p Commercial ❑ Trailer Court L3 Motel ❑ Other ❑ Number of living units: _1-_-- Number of bedrooms -1__-- Number of baths _-.----- Lot size ------- - Water Supply: Public system ® Community system I] Private ❑ Depth to Water Table 25-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [❑ Adobes) Hardpan ❑` Previous Application Made: Yes (j No ❑ Now Construction: Yes ® No ❑ FHA/VA; Yes ❑ No Ex TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) C. Septic Tank: Distance from nearest well---no--------Distance from foundation_ -- 1 ---------Material-------- �pment--------------- ® No. of compartments------------ -----------Size--- - A-4 61 Liquid dept 5.1!3.1._-.-- ------Capacity---W --------- - Disposai Field: Distance from nearest well-.- 19------__Distance from foundation--_ -- �F---.----Distance to nearest lot 1ine-----�0i-___ r ® Number of lines----------------------.-----------Length of each line------��-_-_- ----__-----Width of trench----_ -?----- Type of filter material-----Y'©Ck_ Depth of filter material_---_-1$u- -_---Total length------------------------------------------ Seepage ----- -------------------- Seepage Pit: Distance to nearest well--------nQ--------Distance from foundation----6 ----._Distance to nearest lot line-_® Number of pits-----1--------------Lining material-------x'QCk---.Size: Diameter_-.-_�3"I_-- __ Depth----15-1-----------O---t----------__ CA Cesspool: Distance from nearest well-----------------Distance from foundstion-------------------Lining material--_-_--_------__---__________-_ ❑ Size: Diameter------------------------------------ Depth- - - --- ----------- - Liquid Capacity. ------ ---- ----gals. ----- Privy: Distance from nearest wellEl -.. ---- Distance from nearest buildia Distance to nearest Sot line--- ----------- ------------ - -- ---------- ----------------------- � ---------------------------- -------------------------------------------- Remodeling and/or repairing (describe):_____nQW-.-$ 8 6111 'Orp11g--pgl'QOM •.• one•.,bed••;xoom 1 ----•------------------------------------------•--------------------------------------•----------------•-------•--------•---------------------------- -----------------------------------------------------:------------------------------- ------------------------ -------------------------------------------------------------------------------------------------------------1-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. (Signed)----------- I� I!� ep- d '14�kkrY• C� --------------- (Owner and/or Contractor) �r• rry_ 4: 1rhan [Title) Gen. Mgr" -- ----------------- (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_- _C_�_ _ _�� REVIEWED BY-------�.'�4t22LF - 4t�f.---------------------------------------------�--------------- DATE------------ ��----------------------------- DATE ------------------------ BUILDING PERMIT ISSUED------------------- ---- ------- ----- Alteration nd/or r comm ndations:- - -- c.ztATE`' - Al- tJ = ------------------------ ----------------------------------------------------------------------- �- C . -----------------------------------------------------------" --------------------- ------------ ---- Q1 FINAL INSPECTION 6 :ez- iaYu:� ------- ------ ------- Date----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+ree+ 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5---9-21A Revised 1-57 F.P.CO.