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FOR OFFICE USE: n � --------------------------------------------------------- -------------___------_---------. ---_ (,� V`___- 1 APPLICATION FOR SANITATION PERMIT Permit No. ....f....... .t)� ----- --------------------------------------------- (Complete in D :tate) �/ This Permit Expires 1 Year Fr Date Issued Date Issued .___._:: ��(... Application is hereby made to the San Joaquin Local Health District for)aermit to construct and install the work herein descriibed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION._---366..A:d. idlY1T]®_..qt.-------_- ktQn.......................................... --------------•-•-•-------------- Owner's Name-------------------------------------- Virginia Skinner------------- -•------ Phone---RQ---59905-----••-- Address----------------------•---•----- Sam® ------ ------ Contractor's Name_Trle.._DAY--&-NIG-HT...S--•---T-6---lsv.c-•--------------------------------•-- ------ Phone..----11Q...63.841.----- Installation will serve: Residence XX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I.- Number of bedrooms ___2__ Number of baths .1__.. Lot size ---1.5Q.r....x---!<i5t----------------_---__.--- Water Supply: Public system ❑ Community system ❑ Private M Depth to Water Table 6Q.- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(Z Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ 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 well. ---Distance from foundation.....=.._..Material_________________•-___-____-_.-----_-.--____----. Ex#lting No. of compartments------------------_- ----Size----------------------------_---Liquid depth--------------------------Capacity Disposal Field: Distance from nearest well ----$_Qt....Distance from foundation.....10 ......Distance to nearest lot line $t ;E;:Idsting Number of lines- --1---------_-------- ---Length of each line...2Q -------------Width of trench 2!+1'.. ------ & ADD Type of filter material ae_P_t_"__.R1Depth of filter material-.i$�t-___-_____--Total length.....2.01.................. ......... Seepage Pit: Distance to nearest well---100_'.-------Distance from foundation-------ULL..Distance to nearest lot line....5!........ Xxx Number of pits------1-------------Lining materiaRock------------Size: Diameter----33.............Depth........LS1a.........._..... Cesspool: Distance from nearest well-_______________Distance from foundation--------------------Lining material-_--.--_-_-----_•_•_----._-__---__--. ❑ Size: Diameter---- --- ---------- p ----------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well ------.-----------------------------------------Distance from nearest building--______--__-_--____-___--------_.-____._. ❑ Distance to nearest lot line-----------------------------------------------------------------------.....................-------------------------•-------------------- Remodeling and/or repairing (describe):--------------SUPP7.FA\1 'h1TAEY.-DBAZNAjZ----------------------------•-------------------2-------•-•---------------- ----------------------=------------------------------------------------------------------------------------------•---------------•-----•--------•---------------•------------------•-------•----•----•-•-----•-----•------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)....._'T11.6... AY..&__NIGHT...Septic---Tank---S rmiCe----- ------ ------------------- -- ( �LContractor) By:-------------•---•--------------•--------•-------•-•----• --------------_............................... (Title)-- ---- (Plot plan, showing size of lot, location of system in relation to wells, dings, etc. an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --- ------------------------------------ DATE---- j=......---------------- REVIEWEDBY--------------------------------- ------------------rZ--------------------------------------- ......................... DATE....................................................... BUILDING PERMIT ISSUED —� DATE. - -------------------- Alteratiionrand/or recomm ndations:.. ...... ...... ........ .. ........... ................................... �. • --- ----- ..-------- -------_ ----------------------------------- ---------------------- FINAL INSPECTION BY-.. _ ........ ---- Date---_---- ---_-- . ff` /A1V.............................. SAN J QUIN 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 EV•9 REVIVED 6.59 r.P.CO.2M 6.60