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..... FOR Off idt USE: 7- 3 l !f'- APPLICATION FOR SANITATION PERMIT Permit No. .f c:__3.7�' ------------------- __.. - - - ------------------ -------- ------- --------------- (Complete in Duplicate) ----------------- This Permit.Ex ires 1 Year From Date Issued Date Issued 1..-(. . 3 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. t JOB ADDRESS AND LOCATION...-_-_29.4 -.-Howe_, Ste.e...Stocktvn� Calif Owner's Name-------- -------•-••--------------------- -- Phone--Aq-•--A�39----- z Address....................--•-I0-e-----------------•----- :..........:._.. ------------------------------------------------------------ Contractor's Name-{-------- Delta---Sept]-c•- Tank--S�x'V. ' IIIc. ---•-•..........................•------.... PhoneJ�-e- '3455 . Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: Number of bedrooms _-9-. Number of baths ._- -- Lot size --------- t----%... 4Or....................... Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table3.1 ft. :•` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [3 New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No El 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.................................................. ExDting No. of compartments--------------------------Size-------------------------------Liquid depth.-------------------------Capacity....................... i Disposal Field: Distance from nearest well----A ------Distance from foundation-----1.0---------Distance to nearest 2) t line..:.5r.............. Number of lines..On�@_-11M---------Length of each line-------._---30�_ Width of trench-- -- ----------------- ii.... .-- r Type of filter material...Z QPX---------Depth of filter material----.1._.__----'---.-Total length---......�.�...-------------=---- I A Seepage Pit: Distance to nearest well'_-:T10-:------_Distance from foundation-----�Q-.•.-___-.��E�nce to nearest lot�line..._J'�..`.-._•-.• �- ] Number of pits---OTit----------_Lining material___--_ZT!*------Size: Diameter._--- ---------------Depth.-2S-._--I--�1X.-----_.- .� Cesspool: < Distance from nearest well------------------Distance from foundation--------------------Lining material...................................... S ❑ Size: Diameter---------------------------.........Depth-----------------------------------------------------Liquid Capacity........-..-•F-------------gals. Privy: Distance from nearest well------R---=--------------------------------------Distance from nearest building--------_-._-_._.._._____.___.--.--...... ❑ Distance to nearest lot line.-.-__.----.---------------- .-.- = � ----------- -----------------------------------•-- -------- dd3n Ot_ of horizontal_ leach----------.nd one (1) 33"X r i ~ Remodeling and/or repairing �descrlbe)---- -----------9._3 _-_- .- rack:•fill-e-d_-Fil'liarn-Be.d.-.to...exlotlug cesspool,--dump-----------------------\- ----•---------- tt 0 ---------------------------------------------------------------•---------------------------------------------- ..........--------------------------------------------------------------------....-...------------------- ----------------------------------------------------------- •-------••--------------------- --------------------------------------------------------•--------------------------------------------------------- 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. ! ' 4' (Signed).....--- Del' , ...Sip. a t -- 'v1 ea----1nc„-j-----------------------------------•---------------•--_(Owner and/or`Contractor) By:----......P-_erry.---D.---MaXtban----------------------------------•--------------------------•---- [rtle).Genu' - --------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placei otn-reverse side). FPF DEPARTMENT USE ONLY 07 3 APPLICATION ACCEPTED BY-------•- ------ I--- � DATE---------- •--,,1 --... REVIEWED BY---------------- --------------•------------------------------------------- DATE BUILDINGPERMIT ISSUED--------------------------------------------------------------............. ------------------------ DATE------------------------------------------------------------- Alterations nd/or recommendations:----------------------------------------------------------------...------------------------------------------------------------------ �J� �.�. -c. ` C�:/ -----------IC ......-. -P y r-_... -a 1_-c.._.._ ----------------------------------- ------- -------------------------- ----- -----------------------------------------------------------••------••------ ----- -----------------------------.... f. FINAL INSPECTION BY:--------_•...-' n------ -- :. ! tit Date------------------- ----- ..... ��• <- 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 TraWr California ES 9 REVI6E0 6.69 PM 6-61 ATLAS