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FOR OFFi E USE: APPLICATION FOR SANITATION PERMIT S— Permit No. ..f. .__ ...... , (Complete in Duplicate) __ _ This Permit Expires 1 Year From Date Issued Date Issued ------ ------- - : IT rJ , c --02,0 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 complian with Coujt Ordinance No. 549. { k $Dt1SE? o4 -z-OZ-3 "CD3 vi . °,g 2°,4.��ref F— T�;., off '1' Ironton Rd . p - s JOB ADDRESS AND LOCATION--- rI?adridge... _t,..___at---z r_ve----of_J3t_ in:..Ran_cr_o._.San...Jnaq3.Lin•----•-- Crothers (Sm. Isbell Genf. Contr-. --)-------------•--• -------------- Phone...GR•--74016--------- t Owner's Name •.................................................._ ---•-•--•-----•......................R .....2_,-Bag-:10.75,---f3teaktal- .....•.............................................................. Contractor's NameTl R....DRAY..A.-_UTIGBT---Sept1a__.Tank--`S"erviae------------------------------------------ Phone HQ ..?,�8��........... Installation will serve: Residence)M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: : .___ Number of bedrooms ----3. Number of baths __P____ Lot size :_-123.',:---X...16G,........................ Water Supply: Public system ❑ Community system T$, Private ❑ Depth to Water Table _...... ft. t.. 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 EXX New Construction: Yes NENo C] FHA/VA: Yes [3 No [I TYPE OF INSTALLATION.AND SPECIFICATIONS: 0 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T ,= W I Septic Tank: Distance from nearest well--------2,5CQ6istance from foundation------1Q.--__. -Material._.-CG___HriGk..... .- No, of compartments------ -----------------Size--- ls_x5,6tt--_X___Liquid depth...f4(-...............Capacity.....jWQ...Ga1.�S r 8tt Distance to nearest lot line....- t Disposal Field: Distance from, nearest well--2- 0...__0ista ce from foundation ...._� ....i tt 5 xx Number of lines_________--j"'_-----------------------Length of each lin e___.. •0�*60- _��,.Width of trench___...._2�k_....._________...___ Total len th � Q ---------- i Type of filter material-------_-----------------Depth of filter materi J_._... Q____ g 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_.__.__.._.._______-________.._-...._ Size: Diameter--------------------------------------Depth---------------------...----------------------------Liquid Capacity-----------•--_-------•--gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ C1Distance to nearest lot line- -------------------=------------------------ ---------------•----•---------------------------•--------•-••-----------------------••------- Remodeling and/or repairing (describe)--------- -----------------------------------.--------------------------------------------------------------------------•-•.......................... ...-. w. -------------------------------------------- -------------- -------- --------•----------..------------------------------------------------------...-------- ------•----------------------------------------------------------------------------------------------------------------------------------------------------..------------------•--- I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San JALocalal h District.(Signed).•_The---DAY__�t._N1G.BTSe.ptic---Tan-k--Sery --------------------------- ---------- Contractor) By:•-------------------•..._.---------------I........-------;-------------------------------- ---(Plot plan, showing size of lot, location.of system in relation to a 'ca be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....jl� 5------------------------- ---------------------------------------- DATE---- —---------------------- REVIEWEDBY--------••-------------------------------------------------------------------------------------------------- ---------------- DATE--------.._._.------------------------------------•-------- BUILDINGPERMIT ISSUED-----------------------------------------•-----------•- –------------------------------------- DAT E-------------------------------- ----------------------------- Alterations and/or recommendations:-------------- ----- ----------------------------------------------------- ------------------------------------------.........-•----------- -------------------------------------------- F nz � z I FINAL INSPECTION BY:......�......... ------ --------------- Date-------- fo SAN JOAQUIN LOCAL HEALTH DISTRICT i 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 21A 5-6[ ATLAS r `