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FOR OFFICE USE 1 ------------ ------------------- ------- -------- -- - ------------- APPLICATION FOR SANITATION PERMIT Permit No. ...�_. _ . -- �___-- ._ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Applic tion 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. JOBADDRESS AND LOCATION-----------3-42$--- ----------------------------------------------------------------- Owner's Name---------------- X'�---s�.�l_>il__�'x�?_�.��'�,.�---------------------------------------------------------------- --------------------------------- Phone_._HQA _4-.Q8.',�2---- Address-----•-------AbQYe.----•-••-•-•-------------------------------------------------------------------------------------------•--------------------•--------.,------------•----•----------------••----- Contractor's Name-_-__--Delta---Septic Tank Service. -Inc.-------------------------------------•--.... PhoneHO.....3--1269------ i Installation will serve: Residence ® Apartment House [I Commercial [] Trailer Court ❑ Motel ❑ Other ❑ ; Number of living units: 1--__ Number of bedrooms ---3_ Number of baths .1--- Lot size _5o tXl5Q_e•------------------------------------- Water --- •••••--•--------Water Supply: Public system Ej Community system ❑ Private ❑ Depth to Water Table 45-. ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[a Hardpan ❑ Previous Application Made: (if yes,date-----------,--------I No ❑ New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No 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----------------- from foundation--------------------Material_______________._--_- __________________._-__-. Exfm,'1ng No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity---------------------- Disposal Field chi' Distance from nearest well, ._Distance from foundation..�Q-`_._.._.Distance to nearest lot _Length of each line_______ f f Number of lines-----------�------------ -�Q----i. t ------------- Type length_______��a__________________________ Seepage Pit: Distance to.nearest well_W417.e---------Distance from foundation------1___-_......Dist ante to nearest lot line'---5.--------- ® Number of,-pits___-----1------------Lining material---RQek------..Size: Diameter.----33_----------Depth-25__._Max----------- - r 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----------------------------------------- Distanceto nearest lot line----------------------- ----------------•-----------------------------•--•---•------------------------------------•--•------------ ---- � hf Remodeling and/or repairing (describe):------Ad:Un___Filter-BBC ---tO--- X'�St,1T] ,--5-�8 .9IIl.--------------------------------------- -------------------------------------------------------------------------------------=----------------------------• ------------•------------------------------------------------•-,--------------------------------------- r ------------------ -------------------------•-------------------------------------••------------------------------------------------------------------------------------------------------------------ 1 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. Si ned DG�.�,& G I.0 Tank Ser I31C.- --- ------------------------------(Owner and/or Contractor) ( 9 By:-------------------------T'erry-Wax-tharl -- ----- ---- ----- ---- - ---------------(Title)-----Ge.r1-----M91'--•---------------------------------- (Plot plan, showing size of lot, location of system t - tion to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- --- ------ - ----------- ------------------------------------------- ---------------- DATE------------------ --•------------------------------------ REVIEWEDBY-------------------------------------- -- - --- - - - -- ---- ------------- DATE------- r� �0 ---------------------------- BUILDINGPERMIT ISSUED -----------------------•--------------- DATE------------------------------------------------------------ Alterations and/or recommendatio .- -------------- =---------------- ---•-------•------- --------------------•.............•-------- I ------------------- _ _�__•._..__J --�._.. ---- iI __ _ _________________________ _____ ---------------------------- ------- __________ _______� _ - _-____--_--_ - i- 3 - W -------------------------------------------------------------------------------------------------------- -- -------- FINAL INSPECTION BY---------- -- ----- -- - Date------ � �f------ ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California EE-9 REVISED 19.59 F,P.CC.2M 6-60