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APPLICATION FOR SANITATION PERMIT Permit`No. (Complete in Duplicate) Date Issued ._/_V/47/5_J(._ _ 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-------------1+4.__S4_• Dal+S fit• ----- �-�_Qckbon--------------------------------------------•---------------------- ----- Owner's Name------------} ----------------------------------C-xene---Pax-low-------------------------- -- ---------------------- ------ Phone. Address---------- --------------------------------------------------Same-------------------------------------------------------------___---------------------------------------------------- --------------- j xD20� 6 Contractors Name ------------D:AY---�---�T-CTHT_.__►S._EFTIC---�ANK---SER��E----------- -------------------------- Phone-----------------7--------------- Installation will serve: Residence XX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---3___ Number of bedrooms Number of baths ---I- Lot size ------71---- ____116;_________________.____ Wafer Supply: Public system [UCommuriity system ❑ Private ❑ Depth to Water Table ___50' t. ^' Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ZK Hardpan ❑ Previous Application Made: Yes ❑ No MX New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ Nom 'k* TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weli___N011H_Distance from founda+ion____A0--------Material------f'C---BI'i-Ek------------------- L � rt to No. of compartments_____-.2_---------------Size_�Gt".__�_�?t--X�?3--Liquid depth------ -------------- Capacity----8CS}...Gals• 'I Disposal Field: Distance from nearest well_NQne____.Distance from - foundation____- Q.........Distance to nearest lot line______5-- -------2 -_-------2�-i----------------_-_-_-_- _ Number of lines--------1-------- ------ ------Length of each line-------90-t---------- Width of french Type of filter material--_EP-P_.___Rk_Depth of filter material-----18..._____.____Total length___.____-90__----_--------------------- Seepage Pit: Distance to nearest well---Rorke-------Distance from foundation____4Q=._.___.Distance to nearest lot line______��_____EZX r Number of pits__.__--------------Lining material-_Ro_ck---------Size- Diameter-------3311--------.Depth--------251----------------- D�sf Cesspool:El Size:Diameter nce from nearest welL----------------Depthce from foundation-------------------Liquid Capacity_--____________________- gals.` V' i ----------------------Distance from nearest building......------------------------------------ st ❑ nearest Privy: Distance to elot line l ---------------------------------------------------------------------------•------------------------------------------------------------------ 0 ** ----------------------------------Remodeling and/or repairing (describe):----------------- exist ---5 5 eA1R-- _________________-_ ---------------------------------=------------------------------•-------------------- ----------------------- 9 eb --------------------------•----------------------------------------------•-•-----------------------------------•--------------------------------=--------------------------------------------------------------------- �► ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 +he San Joaquin Local Health District. (Signed)_ DAY & NIGHT SEPT IC TANK SVC J" .? ------------- -- [C� Contractor) ---- - ------------------------------------ 1 location of system in relation to w 240 E' . M�ries Aee . . x0 206 ----------- -----(Title)--------------------------------------------------------------- [Plot plan, showing size of lot. I c y buildings, etc scan be placed on reverse side). FOR DEPART ENT USE ONL APPLICATION ACCEPTED BY-------•------------------------------- -------- --- ----------------------------------------- DATE -- -- REVIEWED BY-------------=------------------------------------- ------ - -----" --------------------- DATE ff -- BUILDINGPERMIT ISSUED-------------------------------- --- ------------------------------------- DATE----------------------------------------------------------- Alterations and/or recommendations--------- ------------------------------------ -------•----- ---------------- --------------------------------------------•--------------------------------------- -------- ------- ----------- s ------------- "� ------------------- ------ --------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:----✓- V_4----------- -------------------- Date__. -_ _ c ------------------------------------- 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-4-2M Revised 1-57 F.P.00.