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i FOR OFFICE USE: _______________.______f. _ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------'i--- - --------------- (Complete in Duplicate) Date Issued -------------.----------------------_------ ---....__... I 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. On Calaveras River teoar-Ripon area.) JOB ADDRESS AND LOCATION.... awel__ tatePar1�;-___- u5tin_Road-_south--of West Ripon Road Owner's Name_State___o.f_California._Dia%isiaxi..of--Beaches--a,nd__Parks---------------------- _____ Phone__-U_3.22-44.............. Address------ has.-..Cugningham, Genl Contr. Rt. 1 Box 392 K; Manteca. -------------............................................................ Contractor's Name---Thst__DAY_.&_ NIGHT__Septie._TaClk__S_erY1C_e-___--- --------------------------------------- Phone..46,6.., 41............. Installation will serve: Residence ❑ Apartment House ❑ Commercial (] Trailer Court ❑ Motel ❑ Other . Number of living units: _.----- Number of bedrooms -------- Number of baths -------- Lot size ----AC_Brag_e_________________________._-__-_._-__ Water Supply: Public system ❑ Community system ❑ Private ift Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------- ---------_) No ❑ New Construction: Yes1W No ❑ 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 weII1001-------Distance from foundation---2,�1----------Materialft-40&0 .__-R4l.f,---Ooncrete Ifik No. of compartments_-_._ -3----- _-__ ----- E_ -_Size_22 -1__11.1_-$-40liquid depth_____5.6!1--------------Capacity-.-..3-00.0--- Disposal Field: Distance from nearest well._.1,4O ___Distance from foundatio 25 ..Distance to nearest lot Iine30_......... Number of lines__ ------------ -----------------Length of each line_____ Width of trench-----11------------------------- Type of filter materiai_Septj.e---Rk_Depth of filter material----._1,9!,----------Total length------------------4XZ------------_ Seepage Pit: Distance to nearest well_____ ________________Distance from foundation_-_________._____-_.Distance to nearest lot line--___.__-______-_ ❑ Number of pits-----------_.._.__-Lining material__-__ __ ----------- Size: Diameter-------------- --------Depth--------------------------------- I Cesspool: Distance from nearest well ----------------Distance from foundation--------------------Lining material----------_--------------._-______-__ M ❑ Size: Diameter- -- ------ ---------------Depth-------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------.----------------------- -_ _Distance from nearest building-------------------------------_-------__ 1 ❑ Distance to nearest lot line.- ------------------------------ -----------•---------------------- ---------------------------------------------------------- Remo deling ----------------------------------------•--------------Remodeling and/or repairing (describe):------------ -------------------------------------------•----------------- ----------------------------------------- -------------- ------------------------•--------------------------•------ -- ----------- -------------------------------------------------------------------------------------------------•-----•------••------------------------- ---------- ----------X�-Resp doom for-state--P&rk------------------------- -------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work ill be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local alth District. (Signed) The I?AX & N CcH'I'--Septic---T k__ServiCe - �-- ----------------------------------------------- fdl�hYI(J131'r Contractor) By:---------------------------------------------------------------------------------- - - ----- ------(Title)--------- --------------------- - ---------------- (Plot plan, showing size of lot.-location of system in relati to wells, uildi s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------. _. -.©- '__--------------- ----------------------------------------- DATE-------47-771-9--- jr REVIEWEDBY------_--------------------- -------------------------------------------------- -------------------------------------------- DATE------------------------------ --------------------- BUILDING PERMIT ISSUED__.._--------------------- ----------------- ------ ---------------------------------------------. DATE--------------------------------------------------- Alterations and/or recommendations:------------------------- ----------------- ----------------------------------------------------------------------------------------------------- .;-------------------------------------- ----------------------------------=------------------------------------- ----------------------------------- ---------------------------------------------------------------- ----------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- ----- - ------------------- ----- ------- ------------------I---------------------------------------------------------------I------------------------------- FINAL INSPECTI Date------- --/77_ - ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.00. - -rA 3 /`/4 V2-