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r APPLICATION FOR SANITATION PERMIT Permit No. ..// .� (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 the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_.--------13"-_�4Is-land----------------- t_a.Ck*an------------------.--- - - ---------------------------- Owner's Name------------- ---Jam-es...PIISS1Dn------------------- --------•--------- -------------------------------- -- " ".. ---------------... Phone----HO.-�"QQ� Address-------------- ?1.6 ------------ ----------- ---- Contractor's Name---TheDAY.-"& NIGHT ,5ePt"ic__Tank_"-Service____,--""_-""""-""-.-"_ ..................................... Phone._-.HQ..2"7046- Installation will serve: Residencell Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:2------ Number of bedrooms .- """ Number of baths .__2 Lot size ------75_,----x___1511--.______"-.--_""- Water Supply: Public system MCommunity system ❑ Private ❑ Depth to Water Table -- Q- ft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe XX Hardpan ❑ Previous Application Made: Yes WC No ❑ New Construction: Yes ❑ Nojm FNA/VA: Yes ❑ No ❑ Supplementary ` TYPE OF INSTALLATION AND SPECIFICATIONS: Drain (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation.------_--s-.----__Material -_-----____-".""."--___"_-_""-"-__ ._ - ---------- xi ing No. of compartments--------------------------Size-----•-------------------------Liquid depth--------------------------Capacity Disposal Field: Distance from nearest well-N_4)le-----Distance from foundation-"_---1_Qr-.-.Distance to nearest lot f ine__15t Exiaing Number of lines----1.---------------------------Length of each line------------ 1 "._.Width of trench"--__..__2"" �t • rr & AI}I)` Type o iter material "F3.,_"_ Depth of filter material"""" -"-_"____."".Total length-____"_" IOt__"" _ ___".- Seepage Pit: Disfance to nearest well axle-------_-_Distance from foundation----ZQ"1-------,Distance to nearest lot line--.---10_t W ExUt j ng Number of pifis---.-I---- ------Lining material-__-$-O_Ck""____Size: Diameter-".� rr -- --------.Depth----------a-5r------------- . ool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-.___---__-._-.--__.__-.---__------. ❑ . Size: Diameter--------------------------------------Depth----------------------------------- --------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well ---_--------------------------------------------Distance from nearest building ❑ Distance to nearest lot line------------------------------------------------------------- " Remodeling and/or repairing (describe)--------------------------------------------- -------------- -------------------------•------------------------------------------- UPPLF 1 .ARY"_D-f3A_TnrA_CTF------------------------ ------------------------------------ ----------------- -------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------ - 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)- DAYGHhptieTank_ Ser is-------------------------------------------------- - --- {( contractor) By:. --------------------•----------------------------------------- -----------(Title)---------- ---- ----- (Plot plan, showing size of lot, location of system in relation o wells, buildin s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �_ - ---- " ------------------- ------ DATE- - REVIEWEDBY--------------------------------------------- ------------- -------------------------------- ----- DATE----------- ----------------- -- ----- - -- BUILDING PERMIT ISSUED------------------ ------------------ �-------------------------- -- -- ------•---- DATE.------------------------------------ - -- ----------------- -- Alterations and/or recommendations:----------------------- --------------"__-- . --•-•----- --------- ' e�.c � �� �X ; ,rte }--------------------- --------- --------------------------------------r----------- FINAL INSPECTION BY:-._(� - _' _ DateV-4 —b Q ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oafs Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California FS-9-2M Revised 8-'59 F.P.Co.