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FOR OFFICE SE: ------------------ ----------------------- -------------- APPLICATION FOR SANITATION PERMIT Permit No. _ z (Complete in Duplicate) Date Issued __.. --------------------------- __ �. _.------ ------------- _."_ This Permit Expires 1 Year From Date Issued 4/1 -- - Application is hereby made to the San Joaquin Local Healfh 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 ---6-------Q•---Drake.------Stockton------------------------•-----------------------•---------------------------------- Owner's Name - -------- -------------------------------B�CkVall _ ----- -- -- HO 2886 ------- ------------------------ ----•- Address-----•-------------------R -----•-••------------`Sr� --------•--•------------------------•-----------------------------------------------•---------••--------------- - --------- Contractor's Name----` k __D_A __&_.NGHT ......T--'----SVC. ----•----••---- Phone.--.-HO---6---81--- Installation will serve: iResidence X] Apartment House ❑ Commercial ❑ Trailer Court ❑- Motel ❑ Other ❑ Number of living units: 1----- Number of bedrooms 3----- Number of baths - __-_ Lot size ---45y_--tx___x-----145_f__------------------ Water Supply: Public system Xj Community system ❑ Private ❑ Depth to Water Table 60--- ft. Character of soil to a depth of 3 feet: ;Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobalU Hardpan [I Previous Application Made: (If yes,date--------------------) No F1New Construction: Yes El .No E] FHA/VA: Yes [INo ❑ TYPE OF .INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200-.feet.) - � C C Brick Septic Tank: Distance from nearest weH__NOI10-__Distance from foundation__._-1O______._.MatariaL______________________________________________ )2 No. of compartments------------------------Size..... -6"_--X---56`t--Liquid depth------5V------------Capacity_12 O---------- Disposal Field: Distance from nearest well _.__IIhone_:0ist 6 e from foundation._ t t Q______._...Distance to nearest lot lins---- ----------- 20-f, __.J�..-___-____ YP 1 1-�-- _------tep fk.ofe"ach line---.------- 20€ Width of trench. 24 - Exerting Number of lines-------- .-r Type of filter materi�l_►5 tib.'__,R�De th of filter material___.�»$___ g 7 & -Add _ ---------Total length 4•None 1. t Seepage Pit: Distance to nearest well __________________Distance from foundation--------10__.`Distance to nearest lot line_,t.�______ Number of pits.------I------------Lining material-----R9Gk------Size: Diameter-_. _='__...___.Depth__..______�5_______________ Cesspool: T -Distance fra nearest well�"`_---_,_-_Distance-f"rom 'foundation___ ______________-1Lining material-------------------------------------- ❑ Size: Diameter--------------------------------------Depth----- ------------- ---•='�-r= •----'Liquid Capacity gals. Privy: r Distan e from nearest well---------------- :-=----Distance from nearest building-------------------------------------------- ❑ Distance to nearest lot line - = = Remodeling and%o' r p ging describe).:____-_AD7-ANG___NTD--_EX- STNG.--BLDG_�_.._A11TD SEWAGE D-------------------------- -- OSAL ... ---------------------------------------------------------------------------SYSTEM_. -- ---------- ----- --------------------------------------------------------------- ------ { -------------------------------------------------------- t 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 '& NIGHT Septic Tank Svc. _---------------- {��ontractor) (Signed) ------------------- - - --------- ---------------------------------------------------- BY:-----------------------------------------------•---------------------•----------------- --•---------•--•-------------- ----------{Title)------------------------------------------------- -------------- (Pot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed ion reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------e - Q—s------ -------------- DATE------ ------------------------ REVIEWEDBY--------------------------------------------------------- ------------------------- ------------------------ ---------------- DATE-------------------- ------ ._._.............------- BUILDINGPERMIT.ISSUED------•------------------------------------------------------–-------------------------------------- DATE---------------------------------------------------_--- -- Alterationsand/or recommend ations:........------------------------------------------ --•----------------------------- ---------------•--._.----------------------------------------------------- --------------------------- -------•-•-----------------•----------------------------------------------------------------------------------------------------------------------------------------•-----------------------------------------_.------------ -------- F ----- � --------------- Date_... ."{__Z.� ` a FINAL INSPECTION BY: �'-- - sr 5- --- --- F SAN JOAQUIN LOCAL HEALTH DISTRICT „ 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street r; Stockton,California Lodir California Manteca,California Tracy,California e6-9 REV15 E9 9-39 F.r+.0 o.3M 6-69 �