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` v APPLICATION FOR SANITATION PERMIT --Permit No. __1../.2-7G-- a *' (Complete in Duplicate) " Date Issued This Permit Expires 1 Year From 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. !$ 'S ------------------- JOB ADDRESS AND LOCATION .- ------- --- � ��ta[BBs *�CkEi�w Owner's Name---- WIw. ' 7 EtA t ' -----------------------------------------------_--------------------- ---------------:----- Phone-------`-•------•-_-------••-- Address-----------------� ------------------------------------------ --------------------------------•------------------------------------•----------------------------•----------•-----------------•-•-------- I Y & NIGHT `I' ------- Phone__aO__2...79-46----------- Contractor s Namer�'iQ----------------------------------��3_f�i�....�_SBr.Ti�6.------------------------------------------------- Installation will serve: Residence:g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___k_ Number of bedrooms __2___ Number of baths _i____ Lot size ------ -____________________________ Water Supply: Public .system :P Community system ❑ Private ❑ Depth to Water Table So.- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Qj Hardpan ❑ Previous Application Made: Yes ❑ NoIg New Construction: Yes ❑ No M 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-_19P20------Distanc from foundation-_Z9 Material-----------)d_o C_________________________ No. of compartments......�-----------------Size__56 x--3b`�_---_--Liquid depth___580--------------ICapacity...000----------.- i Dis osal Field: Distance of lines earest well-_--_--W____Distance from foundation___________________Disten6 to nearest lot line---- - 20 ____Length of each line__ 8'1 Width of trench - 0 Type o€ filter material--pep.___ ____Depth of filter material-_ ___ _______=__._To'tal length____ __________________________________ Seepage Pit: Distance to nearest well_NDne-----------Distance from foundation___30..........Distance to nearest lot line__�4�___.__._ ] Number of pits-_�------------------Lining material__A �--,--------Size: Diameter---3 '�____._-__-.Depth----- -1-------------------- (J� Cesspool: Distance from nearest well_________________Distance from foundation---.----------------Lining material---------____-_---________________-_. ❑ Size: Diameter--------------------------------------Depth-----------------------•----------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------_--------------------------------------Distance from nearest building____________-_______-______--------__--_. I ❑ Distance to nearest loft line----------------------------------------------------------•------------------------- ------------------------------------------------ ------- Remodelingand/or repairing describe)----------------------- ---------- --------------------_---------------------------------------•----•-------------------------------------------------- --------------------------------------------------------------------w---------------------------------------------- ---------'-------------------------------------------------------------------------------------------- it -------------------------------•---------------------------------••-----------------------------•----------------------------------•------------------------ --------------------------------=------------------------------ -------------------------------- -------- ------------=--•-•-----------------------------• •------------------•--------------------------------------------- ------------------------------------------------------------- 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, The DAY & NIGHrf Septic Tank- Service ( Contractors (Signed)--------- - ---------- ------------------------------------------- -------------------- By:---------------------------------------------------------------------------------------•---'---------------------------------------(Title)--------------- ---------------- ------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F R DEPARTMENT USE ONLY ,r— APPLICATION ACCEPTED BY- -------- ---- -------------- ---------------------------------------- DATE-----J -��- -- ----0----------------------------- REVIEWEDBY------------------------------ - ------ - - ----------------------------------------------------------------- -------------- DATE------- --- ----------•----------------------- ' BUILDING PERMIT ISSUED----------------__---------------------------------------------------------------------------------- DATE----------------------------------------------------------- Alterationsand/or recommendations---------------- ------------------------ ------- ------------------•---------------------------------------------------•------------------------ ------------- -------------------------------------------------- ------ ---- ------------------ ------------------ - ------ ----- - ---- --------------------------------- ----------------------------------------------------------------------------------� F€NAL INSPECTIO - - -- ----------- Date-----5------ --/ ------- --- ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca. California Tracy, California ES-9-2M Revised 8-'59 F,P,Cc.