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rvK UrNLE USE: ------------------------------------- . APPLICATION FOR SANITATION PERMIT Permit No, ../-7 .............. - - ----------------- X33 ------------- _ . .(Complete in Duplicate) t This Permit Ex irbs Year From Date Issued Date Issued--- Application ssued __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 LO a " .... "" (on south) CATION. __ t,__17.1 _A,--Mantcas--Soh- t" _Prox_1l2" mild""east""of Austin Owner's Name_____ .fTiUiam_14itche11 - Phone- Address Rd. -------------------------------------------------- -------------- Phone_415-6540204------- Contractor's Address__-_33---Larte...Cour ;_. Qak and="Calif. " i , ---------"---------"----------------------------"-----•----"-------•-------------------•----- Contractor's Name____`'h _.DAT..& 1I x""Septic"""Tank Service ----•---------------------------------------------------------- Phone 3941 Installation will serve: -Residence -"` -- --'----"'-""`-""' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: is"-'Number of bedrooms"%_ t y 3--- Number of baths -- -Y- Lot size" St_"1 _ t Water supply:1 Public s stem Communit s stem Y ❑ Y sY ❑ Private Depth to Water Table ________ ft. Character of soil to a depth of 3-feef:aSand E] . Gravel ❑ Sandy Loam.M da Loam Clay-7.,_ Y ❑ y ❑ Adobe ❑ Hardpan ❑ y� Previous Applicafion Made.({f y_es,ddate .; ) No-El..—New Constriction: Yes No -� ❑ MK FHA/VA: Yes E] _'No E]N TYPE OF INSTALLATIOAND SPECIFICATIONS: (No septic tank or'Cesspool permitted•if public sewer is available within 200 feet.) Septic Tank; Distance from nearest well-----------------Distance from foundation------------- ---------- _." Ma Ekisting No. of compartments- '"` teriai----------- �, ..Size -- -- =-- ,_"Liquid depth Capacity.__ T Disposal Field: Distance from neareswell -DratCl� i -�� Distance fro d 1 =__ Distance to nearest lot line....1Qt 151, Number of lines: y? Length of eacc ni _ J� ----- --- Width of trench--------,�,11--" ----- - -- Type of flier material_ _,5 ,w_,Rlk-Depth of filter material-______1911-____--Total length________________ i .,. -1.5 Seepage Pit; "Ar Distance to nearest well_______________ __ Distance from foundation-------------------- to nearest lot 11n - '---_:_ ❑ .I `. N fiber of pits.-- _--fl�---- --------Lining material---------- Diameter - - Size: __. --- ------Depth---------------------------------- Cesspool- R � ,.Dis$anc�e from nearest well-____________----Distance from foundation-- ______----___ i Lining material ❑ .Size: Diamefier Depth_.- ----------- - jO Liquid Capacity----------------------- Privy: Distance.from nearest well_____.__-_____:. --___ I , -------------------------Distance.from,nearest building.-------------------------------- I ❑ Distance to nearest lot line__..-__________________ ---------------- -----------------------------------1 ------------------------------------------------------- Remodeling - - Remodeling and/or repairing (describe)------------------ a - - --- ==-----------=--------------------------- -------------------- _f ---------------------- :_- I ..�..r - i • - ----------------__------------ = I ! hereby certify tha}'I"have;p`repared this application and that,'the work will be done-in accordance with San Joaquin County ordinances, .State laws, and;rules-an_d•regulations of the San Joaquin Local Health District. (Signed) The DAX & NIGHT Se' ' .-. g ) - tic Tank Service ..-- - Contractor) Dy. ------ --- - - - �. - z.. v (Plot plan, showing size of lot, loca+ionlof system in rela+ion_.to wells, uildings, etc., c n be,placed on reverse side). 1 �...# FOR DEPARTMENT USE ONLY APPLICATION,ACCEPTED.BY7_: ""•_, ---------------------•_•------------------- ----.--- 1 �7ATE J REVIEWED BY = s, � - ----------7 - --------- -- --- DATE------------------------------- - ----------------------------------- --------- BUILDING PERMIT ISSUED---------------------------------------------------------------. ------ ------ - ---------------- DATE 1 t ---------------------- - Alterations and/or recommendations:_____-"_____. __- -- -----------------------------•-------- ------------------------------------------ ------•---------�----------- FINAL INSP TION BY / Date / ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street i Stockton,California Lodi,California 4 Manteca,California Tracy,California C5 9 REVISED B-59 3M 3-'63 F.A.120,