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,FOR OFFICE USE: f��/ �6 ` � Permit No. _.. . .1....3.1 ---- ------------ ------- � ) APPLICATION FOR SANITATION PERMIT j (Complete in Duplicate} Date Issued --- -----------------=---------------- ---___ -- f-U�-.. This'Permit Expires S Year From Date Issued l: Application is hereby made ctont the SanJoaquin Local Health District for a permit to construct and install the work herein described. This application is made i op i ith County Ordinance No. 549. 662 S. Harvey -- -------- J08 ADDRESS AND LOCATION--------- ------ ---- ------ ------- -------------- Hb. 4-3 27Q--- Owner's Name Rev• J.«:.. .„' Wilisme-----------•-•-- -----.Phone----------------- Address 3662__S,. Harvey : ---------------------------------• ---------•------------------.-...-•--•---------•-•-------••-•---• . Delta Se tic Tank Sery Inc* x-1269.- Phone H�' Contractor's Name------ ----•-- ' } Installation will serve' Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ • a x -°°--- Number of living units: _�--_-- Number of bedrooms .1..-. Number of baths _.1 Lot size ___....�............ ... Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table -3.5- ft. Character of soil to a depth of 3 feet: '.Sand ❑ Gravel [I Sandy Loam [I Clay Loam ❑ Clay [3Adobe Hardpan C] Cl Previous Application Made. (if yes,date.._. .- ) No M New Construction: Yes [ Na ❑ FHA/VA: Yes ❑ No i TYPE OF INSTALLATION AND SPPECIFICATIONS: in 2a0 feet.} (No septic tank or cesspool ermil�tedef- ublic sewerDistancvafro lefouhda#• r CeIDellt Yl. g {n ion 1'Q Mai real..C'----------------•-----•-I OO--------- Septic Tank. Distance from nearest �} N l No. of compartments----- -•----- ---Size•----------X------- -•---- Liquid depth- Capacity - ® ` f Disposal Field: Distance from nearest well...n0---- ._Distance from foundation_..- :Q3....----•Distance to nearest lot line..... ......... ® Numbe f.of lines------ ..... =-------------------Length of each line--------------IQ----------Width of trench------Z----------------------- � l fi Type�of filter material--------X'D-�X-----Depth of filter matenaLri --- .._� ---- ----Total length------------ - ----••---------`-•--••- � .fi Distance to nearest well___...-110----_---Distance from foundation_--la�_..--....Distance to nearest lot line..... ......... Seepage Pit'. Distance of pits--------1-----------Lining material---rQGk-------Size: Diameter-----3 �.---------Depth.._ ------mom• Cesspool: Distance from nearest well-----------------Distance from foundation.--._--------..-_.-.Lining materiaL....._..-_.._..........._..___..--- : F -------Liquid Capacity----------------------------gals. ❑ Size: Diame#er---=-----1----------------------------Depth--------------------------------------------- �- Priv Distance from nearest well-------------------------------------- - -------Distance from nearest building...-_--._..._-..-------------_.---------- y:: _ .e .r. _...,. ........� e ------------ Distance to nearest lot line.__...._-..._-.....-- ❑ ----- ` r�ew s e tic tank s _stem Por 2 e o 1 e.------•--------•--------------------------- Remodeling and/or repairing {describe)=-- ------ -- ------ p yp p -----•----....----••----•------------•----------------------------�---------•----------------•---------- -- 4 H = ----------------------------------- -----------•------------------------------------------:--:-#-•------------------------- --- •----- - --------------------------=----------------•---•-------•----•---•----•-----•- -------------------------•---------- ------ --- ------ --- - - - -------- ----------- ---------I`hereby certify that I have prepard +his application and that the work will'be done in accordance with San Joaquin County ordinances. State laws, and rules and regulations of +he.San Joaquin Local Health District. 5Tank Service., I ------------------------(Owner and/or Contractor) {Signed}_ - -------------- f ...._ C qqr 4.p M re ------ Br--------p erry_•_0* War h n------------=--------------------------------------------------------------(Title) (Plot plan, showing size of lot, location of system in reldtion to wells, buildings, etc., can be placed on reverse side]. f FOR DEPARTMENT USE ONLY APPLICATIOCCEPTED BY--------- ---- -- ---^---- ----------- ----------------------- DATEd- p -�`------------------ NADATE------------------------------------------------------------ REVIEWEDBY----------------------------- --------- BUILDINGPERMIT ISSUED------------------- ------------------------------ ----------------------------------------------•--- DA-TE Alterationsnd/or ecommendations:..--__------=---------------------- -------------------------------- /� tars If----------- ------- .-----------------------•-----...------------ -- -------------------------------------- . �.� --------- �� Date---------""-�/� ---------b---------------------------------- FINAL INSPECTION BY------------ ---- - ------ `' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9,9 REVISED 8.59 F.P.GO.SM 6-60