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Permit N . - ° \41 °l�'}1 APPLICATION FOR SANITATION PERMIT 3 i 1 � (Complete in Duplicate) Date Issued -_--------�-'-• described. Application is hereby ereb made to the San Joaquin Local Health District for a permit to construct and install the work herein This application is made in compliance with County Ordinance No. 549. ; ��-� Stockton -- J` 1 j Rose. I"�ar ie Lane. ----------- JOB ADDRESS AND LOCATION..... --- -------------- -- C Phone Grace Evangelical United. Brethren Church --------------------------- Owner's Name------------- RoseMarie Lan._e...-----------------------------------------------------------------------------•---------- Address HO 27o46 ` The DAY & NIGHT---Septi c- Tank Service--------------------------------- Phone----------------------------------- Contractor's Name---_........................---_- Trailer Court ❑ Motel - Other �] ChUre � Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Rest rOoMS 1 Kitchen acres Number of living units: ------ Number of bedrooms -------- Number of baths of size .--___________ _____ ------------------------ De thio Water tAble Water Supply: Public system ❑ Community system ❑ Private p , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [IClay ❑ Adobe[3 Hardpan ❑ New Construction: Yes �] No E] FHA/VA:Yes ❑. No ❑ Previous Application Made: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) CC Brick n # n 12Q0_.g-a1s. Septic Tank: Distance from nearest w Jl IL5° ----Disfia ce fro ndation---1 �-------Material.___=_ Capacity._..._-.-_ No. of compartments-.�------------------- Size.g_ q R t dCe s 2 Distance to nearer# 4ot�ine------- -------- ------------- Disposal Field: Distance from nearest well QQ.--.-----Distance nom founla0 f & Q t------Width of trench-----?A---- Number of lines--2-------------- -----------f Length.of each lin 1$ -- Type or filter mnferial.n� P� k�----Depfih of filter material._.. g --------Total len th ------------------------ -- - 4 romfoundation--2-5-1 ___.Distance to nearest lot line.._2- (---- Seepage Pit: Distance to pnearestaell.�.QO.�-___ ----DistanceROCk Linin material-- -- ------- --- --- Size: Diameter.. .--._...- p �----------- Number of its. --- - ------------ Distance from nearest well from foundation.,- Lining mat , Cesspool: .Li uid Ca cit ❑ Size: Diameter----------------------------- --------Depth--------------------- ------------------------ q Distance from nearest buildin Privy: Distance from nearest well--------------------------- ----------------------------- - + - Distance to nearestiat ine----------------------------- ---------- *r ' - - --------- -------------- - Remodeling and/or repairing (describe ------------=---------- - ------------------------ ----------------- ------------------------------- ----------------•---- ------------------•---------------------------- Sa-----------•- lhereby certify that I have prepared dthis applions the n and that an Joaquin the L war Ball bepq done n accordance with San Joaquin County ordinances, State laws, and rules an The DAY & NIGHT Septic a. S rvic -- � Contractor] t (Signed) - --------------------------------------------- °-------------- W r 9 1 :� Title By: --------------------------------------------------------------- (Plot plan, showing size of lot, location of system in r do to wells, buildi s, can be placed on reverse side). R DEPARTMENT US NLY , DATE---------I1--- --------------------- APPLICATION ACCEPTED BY...------- DATE-------- - -- 1---------- ---------------------- REVIEWEDBY--------------------------------------- ... DATE----------------------- BUILDING PERMIT ISSUED---------------- ---------------------------------------------------------------- :--------------- Alterat' ns and/or recommendations---------------------------- ------------------------- - .------------•---•------ ------- r ___: _- :.-_:_ __ _ r: - _ : :__::: -------- � -� - --- - ------------------------ r- •r .. � '7 --r/177-S - -------------------------------------------Date.- --� - FINAL INSPECTION-.BY SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore S}ree4 814 North "C" Street 130 South American Street 300 West Oak Street - — Tracy, California Manteca, California Stockton, California Lodi, California /9-2M Revises 1-57 F.P.CO.