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FOR OFFICE SE: /� ___....____ ____.____.___..___._---/.-------------- 67 __ o____. APPLICATION -FOR_ SANITATION PERMIT Permit No. _!.. ------------------ -------------------------------------- (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. JOB ADDRESS AND LOCATION------?39-6_...(236� Vail; t � � +------------------------------------ ------••----------------------------------------•-•---•- -- Phone----HQ--?� 2� ---••--- Owner s Name---------...1�.�Ph._I'�CBT'1d�----------------------------------------------------------------------------------------- •-- ----- ---•- - --------- Address-------------------•- 2 Sam__RP d¢r�..�St......Z_tQ_,t�vn-----•------------•---------`--------------------------------------------------•.................................... Contractor's Name,._The._DAY_.&_-NIGHT..SeP_Li_0..Tank__ae.rues..e------------------------------------------------------- Phone..H 638t..Z--------- t Installation will serve: Residence [21X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �`_____ Number of bedrooms _Z Number of baths _1..-- Lot size _501... Water ................................... Water Supply: Public system 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 ❑ Adobe JY Hardpan ❑ Previous Application Made: (If yes,dote--.-----------------) No ❑ New Construction: Yes ❑ No IF FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material._______..-__.-..___--_--__------_-_.___________- ! Fisting No. of compartments--------------------------Size........--.------------------Liquid depth-----------------:--------Capacity----------- -f---••--- Dis osal'Field: Distance from neares well--NOne Distance frorrn foundation....................Distance to nearest lot line__________ &"A'sting Number of lines---------------•------------- - __Length of each line-------�Q�----------.__--.Width of trench.--------.----- ------_2 ` IID Type of filter material�eP#c_Rk---Depth of filter-material.__-.�9_T'._._______.Total length_______��____________________________ (,V Seepage Pit: Distance to nearest well-- �_______-_-Distance from foundation....._2�s-__-_-.Distance to nearest lof line_________ ETNumber of pits------I____._____-Lining material_____RQck--------Size: Diameter---33T° of Depth___2"_�______________________ 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___________________-______- ______--___ -. pDistance to nearest lot line-------------------------------------------------------------------------.........-----•-----------------------•------•------- ---•-- :. Remodeling and/or repairing (describe);--------------------------------------------.---------------------------------------........_---------------------•------------•---•--...._.--------- ...-----••----•--------------•---------.-------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------•--•------------------------------- ------------------- 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 Service (Signed}-. --- -- -------------------------------------------------------------- - -- -----------------------------------------------------------------------( r Contractor) By:--------------------------------------------------------- -------------------------------- ------------ ------------------------(Title)---------------------------------------- ----- ------ -- . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- '- - ------- ---------------------------------------- DATE-------Z ----- REVIEWEDBY------------------------------------- -------------- ------••-•- DATE---------------------------- - BUILDINGPERMIT ISSUED-----------------------------------Ir-----------------{---------------------- --•-•------------ DATE-------------------------•---------•---------------•-- Alterations and/or recommendations:__..-..___-! `'"T �`��- `-�`�/ "(� �'' r ... ozc� yc .Z -�--- ----------------------- ----------------------------------------------------------------------------------------------------------------------------------I---•--------------------------------------------------------------------------------------- FINAL INSPECTION. BY:....A-6. :......_ � ' �7 �s---------- 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 8-59 2M 5-62 ATLAS