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FOR OFFICE US __ _____________ APPLICATION FOR SANITATION PERMIT Permit No. .-.«_C ----------------------------------------•---------------- (Complete in Duplicate) 7 --------------------- This Permit Expires 1 Year From Date Issued Date Issued .--•--.-_---_-`--'�_---- Application is hereby made to the San Joaquin Local Heal+h 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---___4722!!??A&he-rokee-••Lane_ Stgckton Owner's Name---------Le_Q-& E enF'Y'e2i1]aXl---• -----•--• • ----------------------- --------._. Phone-••- -------• Address----------------�`]_28._.CheLr.o_ke_e_._L;ae Contractor's Name---Th.e__DAY-& NIGHT Septic Tank Service - Phone...HO.._6-�81F1 Installation will serve: Residence$] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __2___ Number of bedrooms __�__�umer of baths .__l. afi s e ------P-ach__l2_Q1---X__a54`-___.:.. Water Supply:- Public system ❑ Commurlity systerh-,0" Privai-e`X)- Depth-to Water Table(Q___ 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 [f 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__701______ Distance froml foundation-_I0_t----------Material------CC Brick ----------------------- No. of compartments_____2---------_--------Siz66___3 36---__________.___Liquid de th._____ --------Capacity $OQ GaiS il Disposal Fibld: Distance from nearest well._5Q;.......DiAnc�e fromfouNdation-----1Q1-------Distance to nearest 124ive....2....... Number of lines___..._. eaah--_._____Length of each line____ f 2 g �� T� Width of french--------[--- • - 0 eac�i••---••- Type of filter material-_E-e_p_t.__R]�_Depth of filter material___-_�.$________._Total length_________9------------------------------ \ I . Seepage Pit: Distance to nearest well----1-QQt___ �,Q Distance from foundation____._-_ t 5t .-_._.Dis#ante to nearest lot line................. 2 ❑ Number of pits-l.-.4a. .t+ ----Lining material.....ROCk. Size: Diameter_... r�..._______.Depth--------- fi________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--__-________________________________ ❑ Size: Diameter-------------------- ------------------Depth----------------------------------------------------Liquid Capacity............................gals. Privy: D'istalice�'from ne'"�arest.we7!"___ .'__T�__._-_______ --------_Distance from nearest building._______________..__-._____.________.___� ❑ Distance to nearest lot line--------------------------------------------- Remodeling and/or repairing (describe: --- ----------- - ----------------------------------------------------------------•----------------2---h0UgaS__-moven---in;-__end-�vidual system--f©r each. --------------•-----------------------------------_----_--------•-•-------------------••------------------•------------------------------------------------------------•-----.---------------------------------------------- 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. (Signed)--_--.The---DAY----&---NIGHT Septic Tank Service ( 'Contractor) - - - -- ,-------- •-----------•--•---•-•--------------•- t BY:----------------------------------------------------------------------------•-------- .. _--------------------'-------------- ---(Title)---------------------------------- --- - -------------- (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-------- --- ------- - . .- -- BUILDING .._, -- --------------------- ----------•---------k----• DATE------... _ ------------ '.. .. .- E =-REVIEWED_BY-------•------------•--•--•----•-- - BUILDING PERMIT ISSUED.........:---------------------------------------------------------------------------•----•-----':_. L DATE..._--- -------•------------------ -------------------------- AFterations and/or recommendations:---------------------------------------. - •--- -fir.. a - ------------ ---------------------------------------•-------------------------•-•-------- -- - - _�. `- ............................... ------------------------------------- t FINAL INSPECTION BY:----- ..:.. 5------------- ---------- ---------- Date---- ( 'Z------------------------------- 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 7M 5-6t ATLAS ,