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FURUFFi E.USE: - r 1�3......................... G7� --- ----- ------------------- �- _____- ----.--. APPLICATION FOR SANITATION PERMIT Permit No. ...� ,..11...J.� - ----- ------------------------------- (Complete in Duplicate) /d� --------------- ------------ --------------------------- This Permit Expires 1 Year From Date Issued Date Issued ............. 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. JOB ADDRESS AND LOCATION__-.__:---?73-3!--!35---country club Blvd. . ••----------------------------------------•------------ Owner's Name-----F-r.e d..X,-Gaileex---r...---------•---•-------•------•---------------------------------•-------•----•------•------------ Phone.-HQ... 098.......... Address...............M-5--C.R?3T CUb_Blvd• -� Contractor's Name---------The••-DkY---- -NzGHT --Se-PtLC... ank_--SerV Ce--------- -----. Phone_-BQ.._a$�i-1--------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court. [-]I Motel ❑ Otherl]Duplex Number of living units: --2---,Number of bedrooms--- Number of baths ---a- Lot size ._--10-0-t' .X15Q........................... Water Supply: Public system-OX Community system-E] Private E] - Depth to Water Table .2.2 ft, plus Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cay ❑ Adobe XK.. Hardpan ❑ Previous Application Made: (If yes;date-------------------- No ❑ New Construction: Yes 17 No ❑ FHA/VA: Yes E3 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' ! (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SFptic Tank: Distance from nearest,,.well----None..Distance from foundation-----3..Q--_t--.-.MaterialX---BX-1Ck......................... r EX No. of compartments----3-------------- ---Size-5-`�t-56T13611-_...Liquid depth-----48"--------------Capacity-...V20Q... } Disposal Field: Distance from nearest well----NOne.-Dist�nce from fcpundation.-------IQ'----Distance to nearest lot line.......63� xxx Number of lines'------.3----------------------,-Length of each line...70".7.Q W.Width of trench.------2-411____..--__--.--.--_ Type of filter material..!g9Pt !J%epth of filter material.."-.19�.-_-_--_--_T.otal length..............��Qt .. Seepage Pit: Distance to nearest well--NQne:__.-_.Distance from foundation.:.... .. ! I' i �.Q_-.DIs"nce to nearest lot lin ...6............. ENX Number of pits------if:-.-_-.-----Lining material.ROCk------.--Size:, f.Diameteµ r--48 --_.---.-_- Depth--------12--------=------ ` Cesspool: Distance from nearest well-------f--------Distance from foundation--------------- -Lining material----------..-_.-_:-=-----__---.- ❑ Size: Diameter--; ----------------Depth-------------------------------------- -- ;------Liquid Capacity--.._...--•-•------------•--gals. Priv Distance from nearest,well_`_��:---_'�'�-' _ ------"� Distance from nearest building � Y' - -------- - g------------•----------------------------- ❑ Distance to' nearest:lot line_'"'--='-k-----t----------- ----------- 1_ I------------ ---------•---- -- ; Remodeling and/or repairing (describe):------------------ ------ ........... = �= :-::, _ ------ ..............•--------------------------------------------Dup1-ex.-__�-•...--2.-.beArroas--aid- l---ba-th• ea-a gait• -�. .=' \. t t I hereby certify that I have prepared this application`�and t the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a;d regulations of:the San as in Loc I Health District.", " [Signed)--The---D.AY...&-NIGHT;!._Se tic--Tan.k..Ser4i_ �" T By: - .......:..._........ - - Title) (Plot pian, showing sire of lot, location of system in relation to well buildings, etc., ca placed on reverse side). 14 ( FOR DEPARTMEWJUSE ONLY APPLICATION ACCEPTED BY---- C--- � ----- -------------------------- --------------------------- DATE---- —--------------------------- REVIEWED 'BY-"-------------------------`---...------------------------------- -------------------------- ------------------------ DATE--- _-----------•----•------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations---------------------------------•------------------------------------------------------------•---•--•---•----------------....-------------------------- -------------------------------------------------------------------------------------------------------------- --------------------------------------------•------.-.-..--------------•---------------------.--------- ------------------------------------------------------------------------ ---------------------•-----•------•------------•----•-----------------------------------•--------•--------...-------------------•-•-•-------•-•------ FINAL INSPECTION BY:. ---- -- -------- Date 1-- - - �I P SAN J UIN LOCAL_HEALTH DISTRICT 130 South American Street 300 Weil Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6.89 RM 6-61 ATLAS