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FOR OFFICE USE: --3 C6 --------- - APPLICATION FOR SANITATION PERMIT Permit No- ---------------------- ------------------------------------------------- ------------ ---------------------------- --------------- (Complete in Duplicate) 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. JOB ADDRESS AND LOCATION-----I - --------------------------------- Owner's Name--•----------1h17" ------------ -------------------------------------------- Phone..Gr-----7Q-4594--- Address--------------------------- ---------------- -------------------------------------------------------------------------------------------- ta S#.,Ltic Tank service, Inc. ..........I------------------------ Phone—Mzr—,22.................. Contractor's Name..""--Del-------------- .....--------------------I--------------------- Inc. I---- I Installation will serve: Residence Z�I Apartment Ho.use [] Commercial E] Trailer Court 0 Motel [3 Other C] Number of living units. -Z--- Number of bedrooms -3--- Number of baths __-.i.. Lot size -----1-6-8-acres---------•-------------- Water Supply: Public, system El Community system 0 Private.0 Depth TO Water Table -45. ft. Character of soil to a depth of 3 feet: Sand F1 Gravel F1 Sandy Loam [I Clay Loam [3 Clay C] Adobe OC Hardpan 0 New Construction: Yes Q No Ej FHA/VA: Yes E] No,® Previous Application Made: (if yes,d I ate---------------------) Noog I 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--_----.._ Distance from foundation--------------------Material------------------------------------------------- Exi ft ing No. of compartments--------------------------Size--------------------------------Liquid depth-- ---------------Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation..------------------Distance to nearest lot line...--_-----.-.... ---------Length of each line..---------- •-------------Width of trench.-----------------•--------------- 'xi Eng Number of lines------------------------ Type of filter material-------------------------Depth of filter material-._----..--------------Total length----------------------------------------- Seepage Pit: Distance to nearest well"----2-00-1------Distance from foundation-.2-0y.......Distance to nearest lot line----------------- ff '25r pax. , Number of pits-----------2--------Lining material-----?7Q:P k------Size: Diameter.......�M...........Depf�--------------------------------- cesspool: Distance from nearest well-----------------Distance from foundation--------------- ---Lining material--.--.----.- ._----------------•- - I . -------------:--------Liquid Capacity----------------------------gals. Size: Diameter---------------------------------------Depth----------------------------- ,4 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ --------------------- Distanceto nearest lot line---------------------------------- ---------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--addlng---- ny----a 0.7)U-0-...a.ys-tam; Tf..5.0=f-t......exi.s-ung---horiz-0-n-t.al-l-each---i--S---no---gao-4--new...5Qrf-t-.---j-eaCh a-t-Q--- added - to --replmc-e------- -------------------------------------------------------------------------------- --------------------------.1----------------------------------------------- ------------------------------------ ------------- ----••}---------------------------------- --------------------------------------------------------------------- --------------- --- ------ --- --------I--hereby-certify-- -that I have prepared this application and that the work wilbe done in accordance with San Joaquin County ordinances, State laws, and rules and regulations "of- ie San.PJoa,quin Local H),Mth District. • (Signed) Dej_tja...#5 ------ -----------------------------(Owner and/or Contractor) nk --- -- -- - - --- ----- -------- ..... . ----- ------------(Title)----GCn*---Ag-ro------------ ----------- By;------ -- --- ----- --- -- (Plot plan, showing size of lot, locationem i I of system -r n to wel buildings, etc., can be placed on reverse side). FOR DEPATMENT USE ONLY APPLICATION ACCEPTE ------ -- - ------ -- ------------W------------------ DATE---- ------------------ W By .. ---------- DATE--------------- --- ----- ........................... REVIEWEDBY..........------------------------ --------------- ----------------- ---------------- --------------------- BUILDING PERMIT ISSUED-------------- -------- DATE------ -------L• --- --- Alterations and/or recommendat"jor --0 ,/�:--------- -- -----------� 42,. � --- wvw- FINAL INSPECTION ---- -- - Date------- - - --- ------- -10;R40 40-3--------•------- SAN AQUI OCAL HEALTH DISTRICT 130 South American Street 300 West Oak SiToet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 RMSED 8-59 ZM 5-62 ATLAS