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APPLICATION FOR SANITATION PERMIT Permit 140. .__ _ I" (Complete in Duplicate) /I Date Issued T plical-ion 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---------2Q0-5 03v—o-o a, 't-oz Owner's Name--------------------------------------- Brwst Bolter --------- ------------------------------------------------------ ------- Phone---------- Address----------•---------------- ---------------same Contractor's Name.______..___AY_-�:_NIGHT 86T. SVC, H0 2-7046 - - ------------------------------ --------------------------------•------------------------- ------ Phone--- •------------------------------ Installation will serve: Residences Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: _1__._ Number of bedrooms Number of laths ._ __. Lot size __5p1_--X "120t ' Water Supply: Public system ® Community system ❑ Private El Depth to Water Table ___40#t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe S Hardpan [) r Previous Application Made: Yes ❑ No [4 New Construction: Yes ❑ No ❑ Supplementary Drainage. 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-_"___________________..- No. of compartments�iStin -g partments--------------------------Size--------------------------------Liquid depth--------------------------Ca acit I Disposal Field: Distance'from nearest weli.............. Distance from foundation___.__.............Distance to nearest lot line-______________-- [idristjng Number of lines-----------------------------------Length of each line----------------------------- Width of trench YP ----------------.-----_"-_- T e of filter nIafermi---------------------- _-- Depth of filter material_--.-------t_-" ----Total length------------•-------•--------------------- Seepage Pit: Distance to nearest wefl..30ns----------Dista undation----__A5,._••, stance to nearest lot line-141 Number of pitsi___"I..............Lining mate ial_Ar3Ck-_ 3311 t Size: Diameter . ----"-Depth-...2-r'---------------------- Q ---------- Cesspool Distance from nearest well_____________ __Distance rom foundation.:---_------.---- _,Lining material--..___-..________-._________ ❑ Size: Diameter:-�--- --- - --- ------- ---- Depth----------------------------------------- ----------Liquid Capacity-.--. ------------- ----gals. Privy: Distance from nearest well--------- -------------------- ) 1 ---------------------Distance from nearest building___""___"_.____"_----"--_•- ----- .. Distance 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. (Signed)___ DAY& NIGHT ••-------Septic-Tank-SerAWs-------------------- ---- �.a Contractor) By: i20fi So. Eldorado HO_Z-7Q�; ---------- Partner e� i -- ---------•-(Titl p St l:io -------- -- [Plot plan, showing size of lot, locao�ion Sf"trn in relation to ells, buildings, tc., can be laced on reverse side). ` FOR DEPARTMENT USE ONLY ----------------- APPLICATION ACCEPTED BY---------------- REVIEWED BY ---_-.--"----__ � _ ------------ ----------------------------- DATE--------�---- •---------------------------------------- DATE__._.--- ---- y BlJILDING PERMIT lSSRJED----••-•-------------------------...�- ``> i`1 DATE Alterations and/or recommendations:_-.__...__--- "- ,-_ "-"""'---`•------•----- - ----- -- - -- - 1 ----• - - - -- ---------- ------ ---- r: ' = ::::::: -------------------•------- --- - i -- ------------------------------- FINAL INSPECTION BY--- - r --------- _ Date------ --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21W 745446 ATWOOO 12-54