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FOR OFFIC US �I�.___ APPLICATION FOR SANITATION PERMIT Permit No. . T.? (Complete in Duplicate) ---------- ---- ------------------------- --- - This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made!�o 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.- . � JOB ADDRESS AND LOCA��TION-•.Rt.._ 1 Bx._188 Lindon F Owner's Name______________ R Gr.--Celt�r Phone. r "9 Address---------Comst-Qck._Road..,-e------mile_s----E.a-st---.of--A near__) ea . nn_.ear h. --------------- ---------Contractor's Name--- 1DAY- &_ NTG1T Se Ts .-------• -- --- �._ .k.._SQ 4 Phone..HO -.0— a}# -3..... ------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units., ._1-__ Number of bedrooms ._ --_ Number of baths 2_____ Lot size __�a _-_�(,►��a� ------------------ Water Supply: Public system ❑ Community system ❑ Private [X Depth TOWater Table}�0*_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ZK Hardpan Ej Previous Application Made: (If yes,date------------ -------) No ❑ New Construction: Yes ❑ No Ej[XFHA/VA: Yes ED No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or ces'pool permitted if public sewer is available within 200 feet.) Septic Tank: Distance tom nearest well_________________Distance from foundation-------------------- Material L`7H5i$g No. of colmpartments------------- ------------Size--------------------------------Liquid depth---------------- Capacity ------------------_ Disposal Field: Distance from nearest well ---100.t--Distance from foundation..._ Q1-------Distance to nearest lot line-__---�IQ� $Ming Number of lines---_------------Z----------------Length of each line-_10i of trench___.__ ...................... Type of filter materialiiji ._,$_e-pt1C-._R�6epth of filter material-------� ----_- _Total length Seepage Pit: Distance tib nearest well -'.-_-----_Distance from foundation__--�Q:1__---..Distance to nearest lot fine......4O.-t.- Number If pits__________________Lining material-Rack----------- Diameter___- ft Depth 2 Cesspool: Distance from nearest well----------------- from foundation______ ____________Lining material__.-___.___________-.._____._____. ❑ Size: Diameter11i ----------------- --------- ----------Depth--- ------------------------------------------------Li Liquid Capacity q P tY ---gals. Privy: Distance fhom nearest well__________________- ------_-_----Distance from nearest building ❑ Distance to nearesfi lot fine_________________________. Remodeling and/or repairing,;(destribe):-----------------------------.--------------------------------------- --•--------------------•---------------- -------•--•------•------------•------•---------------•------------•----------------------------------•-- ----------------------•---------- ----•----••------•---- -----------------••--------•-----------•---- -----11:---_-------aUPPLAMeNtAr_p__DrA1NT------------------------- - ------------•----------•--------------------------------- �� q ----------------------I——...-------------------------------- I hereby certify that 1646 prepared this application a t the work will be don in accordance with San Joaquin County ordinances, State laws, .and rules and regulations of the S n Jos in Health D' riot. (Signed).-•-.The.._A-A'y---s ---NI TS-ept3c_..Tank-- r- -c ------ ---- By:__... I� Contractor) - ----- -- -- --- -- -----.(Title)---•-------------------•-- - (Plot plan, showing size of lot, location of system in relation t buildings etc., can be placed on reverse side). �I. t FOR DEP TMENT USE ONLY APPLICATION ACCEPTED BY�-____ '___-- -------------------------------------------•---- DATE------ �� 3 REVIEWED BY IM.. - ------ -------------------------•-----------------------------. DATE------.--------------------------------------------•-------- BUILDING PERMIT ISSUED___...K�________----------------------------------------------- Alterations and/or recommend inions:---------------------------- -•---••-----•----• ---•-------•----- ---- .. ---------- •--------------------- .--- ----- 2 ----- FINAL INSPECTION BY:.. /J - ----- Date----------- , SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 405 West 9th Street Stockton,Cafiforrtfa Lodi,California 4 REVISED 8-59 2M 5-62 0.rLA3 Manteca,California Tracy,California ES