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I FOR OFFICE USE:/� /5- r2 5or APPLICATION FOR SANITATION PERMIT Permit No.- _s------------------- ---f _— ----------------------------- - --- --- --------- ------ (Complete in Duplicate) _-.-_.---.-.--:�. -��Tf�is permit'Expires'1'Year-From-Date - Date Issued �S . ------------------- ---------------- , Application is hereby made to the San Joaquin Local Healt ict for a permit to construct and install the work herein lest ribed. } This application is made in compliance with County Ordinan e N . 549. ` ST STOCKTON I' JOB ADDRESS AND LOCATION--.._ - ------------------------------------- ------------------------------------------ ----------- Owners Name T :ODiA €3- AIJ),;.0 ---- --- ---------------------------- -------------- ------------------ ------------------ Phone----• 628 ------- Address----•-----------------------ME--t-----------------------------------`-- � �k - -------------------------------------------------------• -•------------••----------------------------•-------------.------ .. i Contractor's Name--------The DAY & NIGHT._-Septic Tank Service Phone..- ''3 ------------ 4 Installation will serve: Residence [ Apartment House±❑ Commercial ❑ Trailer Court E] Motel E] Other L] , -� bedrooms'-3---- Number of baths ----�' Lot size ---100t-X--1.00x-----•------------------------ Number of livingunits: �_ Number of bed Water Supply Public system [� Community system ❑ Private ❑ Depth to Water Table _59rft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe OL Hardpan ❑ Previous Application Made: ,(If.yes,clatte-------------------- No'[-] New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ sir-{L r is TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.) 5e tic Tank: Distance fromn nearest well-------------- "Distance from foundation--------------------Material----------------------------------------------- No. ---____-..___--____----..-.------_- -----No. of-compartments..................... ..Size-------------------4------------Liquid depth---------------- --- Capacity----------------------i Disposal Field: Distance from nearest well-None--_'-Distance from foundation---.204--------.Distance to nearest lot line-__]AC-_ '. KMTING Number of lines------- ------------------------Length of each line----3.�_.-----. Width of trench....2:a $t j}f} 35 Type of filter material-Septic Rk Depth of filter maferial---:.--19 ..------.Total length 3ot---_------'--'__►__- ,0 _ ------ " Seepage Pit: Fstance'fo nearest well _-NOng--------Distance!framfound tion__'5O$_-.Y---.Distance to nearest lot i� --g�-' 0 Number of pits.-------1--------.--Lining material----dock--. -..Size: Diameter--V.---_--- ----Depth----- ........----------------``*g 1 i ❑ Size: Diameter-------------------------------------- - - ----------`"°n--------- ----------Lining material-----------------------------------� Cesspool: Distance from` nearest wail___ __ ____ _Distance from foundation -1 Liquid Capacity___-_---------------.---:--gals. Depth------ -- --- �a � Privy: Distance:-from nearest well------- -------------- - ------- ---------Distance from nearest building-------------------------------- A' -___-___ ❑ Distance to nearest lot line_--------------_----------------- 1 w --- -----------•-- 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, a ` les and regulations of the San Joaquin Local Health District. I (Signed) - -- l� t-------- {Or Contractor) �E�TC TANK SERV1 ------------------- -------------------- I By:----4MlSF-MinerAve.,.t-HD•-6-384f---------- ------- --------------- -----------------------------------------(Title)------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY !,.. APPLICATION ACCEPTED BY---- --------- ---- -------------------------------------------- DATE------ --`---..I 5 i(r REVIEWEDBY------------------------- - ---- - ---------- ------------- ------- ---------- ------------------------ DATE----- - BUILDING PERMIT ISSUED------------- - -� '". ------ DATE---------------- ----------------------------------------- Alterations and/or recommendations-. �'�" (/-- -ter- = ------------------------------------- --- "� - -------------- ----------------------- FINAL INSPECTION BY:- C-{ ------------------ ----------- Date----�57ZA-----�S----------------------- - -- -------------- f i SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Ha:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Seet t Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.