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FOR OFFICE-USE: V /3 y! P4 A /0 ;t�.tJEi -___`��____.________ __-.__ APPLICATION FOR SANITATION PERMIT Permit No. Q.l�..o -------------- ---- (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 theork herein described. a: This application is made in compliance with County Ordinance No. 549. (Kantecarea) JOB ADDRESS AND LOCATIONAUSTIN RUD.. 2nd lot north of Iouise Yvd,., west side ..Parcel 5 -- ------- ----- -------- _- -------------------------- Owner's Name-----Chas. Cur�niiaghaln� Menlo Coutr, -------- - -- ------- ----------------------- -------- Phone------------------------------------ Rto 1 Bx 392 K; YAuteca., Address------------------------------------------------------------------------- Contractor's Name-------The_DLY & NIGHT Septic Talk Service Phone 46E�..384l - ---- - ----- ---- - -- - ................................... Installation will serve: Residence;$ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I.__ Number of bedrooms'_3-_'__ Number of bathsl -__- Lot size Water Supply: Public system ❑ Community system ❑ Private 4 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adie ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes A No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pubtlic sewer is available within 200 feet.) Septic Tank: Distance from nearest well_____©---------Distance from foundation---10-t----------Material_-__Gmncrdte------------------------ No. ---_----_---- _---No. of compartments-----2-------------------Size---4!xl!x(3�_..Liquid depth---5.6!--------------_Capacity...12----ta'.®. Disposal Field: Distance from nearest well__5ot----.._Distai5h� fTorrr foundation 201_____________Distance to nearest lot line_____15�_____ [Y] Number of lines"___ ______ -_ Length of each line------7$t ___Width of trench------- � Type of filter materiaL4']3tC ffit__pepth of.,filter mate�ial� �- Tp.,{ f; lg�lgbb._:,��„ ..; _ N Seepage Pit: Distance to nearest well.---------------------- ___-____- -------- nearestline Distance from foundation _ Distance to lot l _. ❑ s Number of pits---_-----------------Lining material-------------- --------Size: Diameter-----------_ _ _____Depth-------------------------- Cesspool: _______ ___--_Cesspool: Distance from nearest well ;,,Distance from foundation--,-----------------Lining material-------------------------------------- 0 _ . ._ __--__ __._ __-- ❑ itSize: Diameter.—_:__-b - Dh----- - -- # ;Liuic C" acitY gals. Privy: i Distance from nearest well '_______---- _._________Distanc from e`st buildi - ❑ x Distance to nearest lot line-----------------------i w ___ Remodeling and(or repairing (describe)=-- ----------------------- ----------- �. �.--------------I_---------------------- ---------- ------- ------- --------- -------- ----- - ----------- -- --- --- - -- -------- - ------- --------------- - -- d s - - - ____ _ ____ _ ________ F----------.-------------------------------------- ______ __-__ ------------- ---------- _________ ________ ____ --------- --------------- ---- ___ ____-----------------___ ____ ________________a-;-------- }___.rte„ --sem--.° -------------------------I------ ,�_--________--. __ __ I hereby cejtify that I have prepared this application and that the work will be'done in accordancewith San Joaquin County ordinances, Stato laws, and rules and regulations of the San Joaquin Local Health Dj*L t.,,„ (Signed)_Thl ____- __& NIGHT septic Tank Service ----------------- ------ ----------------------------------------------------( Contractor) (Plot plan, show' g size of lot, location of system in rele+ion to wells, .buiWass,tts;.,„.ca rbe-placed,on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ----------------------- -- ---------------------- ------ DATE---- ---- REVIEWEDBY------------------------------------------- ---------------------------------------------------------- ----.- DATE-_--------- -------- ------ - BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------------------------------- Alterationsand/or recommendations---------------------------------------------------------------------------.----------------------------------------------------------------------------------- --------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- -------------------------------------------- A�71 --------------------------------------------------------------------------------------------------------------- ------------------------------------ --------------- ---=-- ---------------- -- --------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:. -- - ----- ------ ---- Date-----_.-�----- C SAN JOAQUIN LOCAL HEALTH DISTRICT �y. 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.CC. - - - -