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f FOR O ICE USE: APPLICATION ff711"SANITATION PERMIT Permit No. .1._'-_ 1�_ --------------------------------------------------------- (Complete in Duplicate) --------------------------------------------------------- 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. J08 ADDRESS AND LOCATION .22.7__E_..._E CIid;-- taakf?T1. .-•..........................•---•-----•--•---------•------------------- Owner's Name..................___•---•---•------U._-- C-_--TeX•ple-C---------------------------------------------------•---...--------..__ Phone..Uo..69x,.28-------.. I Address._.....-------................................•......PAmIP----------------------------------------------------.......---------••-------------------•...................................................... Contractor's Name----The---DAY...&, .NI.GHT Se tic._TankService . ........ . ..... -_• ------•. Phone..Hp6 81+1__.._.__ Installation will serve: Residence KK Apartment House ❑ Commercial ❑ ]Trailer Court ❑ Motel E] Other El Number of living units: a..... Number of bedrooms ___ __ Number of batFis _ of size ..._...5Qt._.:R..�:2 �_______________________- Water Supply: Public system XX Community system ❑ Private ❑ Depth to Water Table ___.___. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)M Hardpan ❑ Previous Application Made: (if yes,date_---_--______--__.) No 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-----------------Distance from foundation--------------------Material_______-_____________------------..-..--•----_-•. ERLSt ing No. of compartments--------- Size-. .......................Liquid depth-------------------------Capacity-----........... Disposal Field: Distance from nearest well_-None_,_Distance from foundatign.. r E�3Csp Number of lines______________�-_____________-__-Len Length of each line_._,-__'+��Q'_---___..Widthtoft trech-24.1---�-----t tin Type of filter material-------------------------Depth of filter material-----------------------Total length--------------------------------------------- Seepage � & ADD Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material------------------------Size: Diameter.......----------------Depth--------------------.------------ Cesspool: Distance from nearest well-----------_----_Distance from foundation---------___-_-...Lining material------------------------------------- t, l ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------------- ........gals. - Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building.-.--------------------------- m 11 Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------- `I Remodeling and/or repairing (describe) I$- app leInent-ery...G•Iraimage-------•----•------•---- ................................................... --•-------•-------•----•------•-•--•-------------------- •-------- ----------- -------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------•-------------------------.--.•-------- ----------------------------------------•-•----------•------------------------------....--•••-----•--•-- ---- -------------------------------------•------------------------------•-•••-------...----------_- •----•-------- I hereby certify that I have prepared this ap 'on and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules end regulatio of th S uin Loca] Heal+h District, (Signed)•--� A & N CGHT ep �- --Tan --S ryl- --- ----------- --------------------------------------------(� Contractor) $y� ------------------------------------------------------------ -- . . ---------- -- -------------------------{rtle)---------------------------••--------- (Plot plan, showing size of lot, location of system ' tion to wells, build n , etc., can be placed on reverse side). 4R DEPZR7sw Uk O LY APPLICATION ACCEPTED BY------- / `"'- - --------------------- DATE....------.. REVIEWEDBY-------------.........--•------•- - - --------------------------------------•----------------------- DATE------------=---------------------•----... $UILDENG PERMIT ISSIIED - ----------------------------------...--------•--------------------------------------------- DATE.------ - y� --------------- Alterations and/or recommendations -- .` -5_� -------� a4_ � r ------- --------------------------- --�---------------- .__ ...- -- - r,�_�.�'...--1,�--•---�t:.o-.t-i��•_-•�•..,E,...�.-- z--r�st�, ----------------------------•-----------•--------•--•--•-------••-------•---•---'--'--- ....-- ........... -•----•-----------------•----------------------------------------------------------------------------------------------------------------------------------------------------• FINAL INSPECTION BY: L /� ,,.�._� Date `�-=�--�--(�---`- --�------------_----•--_----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 YM 5-61 ATLAS