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APPLICATION FO,.,--jANITATION PERMIT (Complete in Duplicate) Permit No. .4. 3//.:� -___.. • Date Issued _t__�-_Z Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here -in described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION ---- 1820 E ...... 0th' Owner's Name ------Jess and.MaTg p2 __Vindiola -9 e' � Address ----------------182..................... 0 k 626 Contractor's Name---------------------------------DClta Septic Tilk ►gC3°VICe+ 1119. Phone__0•_...`"-12E9 Installation will serve: Residence KI Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: 1 ----- Number of bedrooms ... 3__ Number of baths 1__._ Lot size --- 5U1CLQ----------------------------------____ Water Suppiy: Public system [IF Community system ❑ Private ❑ Depth to Water Table4o-__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 29 Hardpan ❑ Previous Application Made: Yes ❑ No [R New Construction-. Yes []t 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 ------------ a----- Distance from foundation___________________ Material____--._---..__.__..__..___-_...._.-_..__: ______- 141sting No. of compartments -.-I --------------------- Size -------------------------------- Liquid depth --------------- ---------- Capacity ----------------------- Disposal Field: Distance from nearest well ---- .'............ Distance from foundation -------------------- Distance to nearest lot line_________________ Ejasting Number of lines----------------------------------- Length of each line ------------------------------ Width of trench ------------------------- ---------- Type of filter material ------------------------- of filter material ------------------ _------- Total length _-____________________ Seepage Pit: Distance to nearest well --- g0 ------------- Distance from foundation__._AVRa0Distance to nearest lot line____ ________ EI Number of pits ------1 ----- .------- Lining mate rial-_1'OCk----- ----Size: Diameter .... 30 ------- ----- Depth ----------- 25!-------------- q Cesspool: Distance from nearest well ----------------- Distance from foundation -------------------- Lining material ----------------------------------- --. ❑ Size: Diameter--------------------------- ----------Depth----------------------------------------------------Liquid Capacity ---------------------------- gals. d.. Privy: Distance from nearest well ------------------ _------------------- _---------- Distance from nearest building -------------------------- ._---------_-_-- ❑ Distance to nearest lot line.--- - -- ---------------------------------------------_---------------------------------------------- ---- --------------------------------- 11" Remodeling and/or repairing (describe): ----------------------- adding --- eepage__Pit--- °_..exi tin --eep 3c__system l , e -• 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)_ .............. -------------------------------------------------------{Owner and/or Contractor) By:---------- ----------------------- Pbrrg_}Wartha.n--- ------------•----_..--------------- •---------------- (Title)_4012•--- ------ ---------------- [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-------- -- - - --- --------------------------------- REVIEWEDBY ---------------------------------------------------- ---- •-------------------- DATE------------ ---------------------------------------- BUILDING PERMIT ISSUED ------------- ---y-----------------•---------------------------------------- DATE------ ---------- ----- Alterations and/or recommendations: -------------•---------- .__... ,�,�' �a � - �� ._.t✓ },,{ � r �r �!i-------------------------------------------------------------- ----- ------------------------------------------------------------_..-------------------------------- --------------------------------------------------------------------------------------------------��---------------- ----------------------------------- ----------------- ------------ -------------- ---------------------------------------------------------------------------------------------------------------------------------------- _. FINAL INSPECTION BY------------------ 4---------------- --------------------- Date------- `--- ---�--- 5 �-------------------- ------ ----•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Er. -9-2M 145446 ATWOOD 12.54