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APPLICATION FOR SAk.,ATION PERMIT Permit No. (Complete in Duplicate) f Date Issued --- lication 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 CountyOrdinance No. 549. 47— ..__ r = _ JOB ADDRESS AND LOCATION--- Rt-,-- _4, Sox 470--A, sockton� �» lith---house ash the Santa Owner's Name--- oa_&pain,-ane-__Bafley� -- Fe Railroad tracks on West --bode of Mariposa Address-----Atm-- , H� -_x'79-=_� Road--`---ajPproxlmateiy--5---mj-je --gym---town: -------- i Contractor's Name---De__:CA Se tic Tank rvice Inc. p ------e------------ 3 --c - ' Ho— 126 ------------------------------------------- Phone--- Installation will serve: Residence [$ Apartment House p Commercial ❑ Trailer Cour} ❑ Motel ❑ Other ❑ Number of living units: --1--_ Number of bedrooms -__-- Number of baths ---I,--- Lot size --2 _-- CBB_- Water Su I i Public system - ---------------------------- Supply: y Community system ❑ Privateg] Depth to Water Table --3 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam y ❑ Cla YLoam ❑ Clay [:] Adobe g') Hardpan ❑ Previous Application Made: Yes ❑z No ® New Construction: Yes Eg No E] FHA/VA: Yes [] No [a TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Exi;�ing Tank: NoDistance co from mares+ well-----------------Distance from foundation_---.-_---_ p mpa Material --------- 1 encs------ -------------------Size-----------------------------_--Liquid depth---------- Capacity -- Disposal Field: Distance from nearest well__ __Distance from foundation-_-__----__----_---.Distance to nearest let line_---__-.---.-_ Exiling Number of lines-----------------------------------Length of each line--------------------- Q Width of trench ----------- Type of filter material-__----------__----_---Depth of filter material------------- N ` ---------Total length----------------------- Seepage ------------------- ----- , Pit: Distance fio'nearesf well------ iflt t Distance from foundation___________________Di�a nce to nearest lot line-.-5__-_-_- _ ( Number of pits---7-_-- -----_-- Lining material-- 'OCk----- -Size: Diameter ---- ------------ --Depth-----25-""gt• IDAX. Cesspool: Distance from nearest well---------------- Distance from foundstion--------------------Lining material _.--__El .__-_-.-__---___ ------------- Size: Diameter------------------------ ---- --------Depth----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well_---1----_'-----_._---_ ------------------- Distance from nearest building � Distance to nearest lot fine ---------------------- -------------------------------------------------------------------------- - Remodeling and/or repairingdescribe :------ad�.in l � J 64ding g---eEe.�-age---'p�t__to___ex�.atin�--system---• ------------------ ------------------------------------ ----------------------------- ---- -----------•------- -------------------- --------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in a ordinances, State laws, and rules and`regulations of the San Joaquin Local Health District. ccordance with San Joaquin County (Signed)---------------Del-t-a.-Aeptic----T_ak--Seryj-ce_ enc+ -------------------------- ----______-----------------(Owner and/or Contractor) BY:-----------F'��r-Y•-0- -��r�hg ----- --------------------------------------------- Qen M . ---------- --------- ----------- ---------- ----------------------{Title)-------- "--- r -- �--------�------- ---- -------- (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------ -------' REVIEWED BY------------------------------------------------- ----------------------- ----------------------------- --._ DATE------- i BUILDING PERMIT ISSUED_________ -- -- - ----- _-------•---------.----- -- ------ ------------------------------------- DATE- Alterations a d/or --- -- ---------------------- ------- ------------------------------- a ------- --------------------------------------------- ----------------- --------------------------------- ----------------------------------- r FINAL INSPECTION BY-------------- --- --�� Date ---- -� ------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT F 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9-2M : Revises 1-57 F.P.CO.