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✓�{�"-- - 3��-Jr�� APPLICATION FOR -..,NITATION PERMIT Permit No. 1,2-1-2414 (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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.------3419---Voiney Owner's Name---------John and Arlean Greathouse - Phone Ho' ------------------- Address 5397 Address_____________________2428 East 9th St, Contractor's I`lame_Delta Septic Tank Service, Inc. , Phone._Ho. �-p9`-0--90 Installation will serve: Residence ❑ Apartment House ® Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___3__ Number of bedrooms __-4__ Number of baths A- Lot size -UP--- __15a.__.___. ----------------------- Water Supply: Public system jZ] Community system ❑ Private ❑ Depth to Water Table45___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan ❑ Previous Application Made: Yes ❑ No [X New Construction: Yes [jC No ❑ FHA/VA: Yes.❑ No [X 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--____.._________________.________------__-___. ExD3ting No. of compartments--------------------------Size------•------------------------Liquid depth------------------------- Capacify----------------------- Disposal Field: Distance from nearest well-----nq------Distance from foundati n__ at_._______-Distance to nearest lot line...!IV________ Number of lines----------- _--------------_------Length of each line______ _T_.___-_______---Width of trench______zt__.___-__1. - ---------- Type of filter material_________________...___Depth of filter material------- -------------- length------------------------------------------ a I Seepage Pit: Distance to nearest well____.___nQ-------Distance from foundation_____ _____________Distance to nearest lot line....5-------.-- KI Number of pits---------- ----------Lining material-____x'QCk------Size: Diameter-------36..........Depth---25-t----Maxit-------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____.--_________________._________- �\ ❑ #' qCapacity---------------------------gals, ize: Diameter------------------------------------- De th----------- ---------------------------------------Liquid Privy: Distance from nearest well------------------.._____._______________---.-Distance from nearest building___--------------------------------------- ❑ Distance to nearest lot line �, Remodeling and/or repairing describe :---_-- er BE'd t-o existi11 8 S L'IIl• Bad n hQr_i._ v tal__1-e.acb---t4 a l_ _ - ng---AM=--------• ---------------------------------------------------------------------------- ------------------------------------- ---------------------------------•-•-----------------------------------:-------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------ ------------------------------------------------------ ---------------------------------------------------------- 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)----- Pelt&--Se,T-)-t1-c---Ta- _err ---------- -------- -----(Owner and/or Contractor) By:__.�'Q r.y--Varlh€m. -- - -- -----------------------------------------(Title)----aen. Mgr• (Plot plan, showing size of lot, locatio'a# system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - - DATE----- -- - -- ---------------- --------- REVIEWED BY-------------------------------- ------ ---- ------ DATE------ ------- BUILDING PERMIT ISSUED---------------------------- - ---------------------------------------------------._ DATE Alterations a d/or recommendations-------------._- ______-------------_____�_._ -----------------------------------------------------•--------------------------------------------------------- - -----------------------------------------------------:-------------------------------------- --------------------------- ----------------------------------------------------------------------------------I------- -------------------------------------------------- --------------------------------------------------------------------......... --------------------------------------------------------------- ---------------- i FINAL INSPECTION BY:-(!...----� ---------------------------------- Date---3 ----------------- ; SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised V59 F.P.Co.