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.�� APPLICATION FOR SANITATION PERMIT Permit No. .�',1_�'�__.�..�7.-� - (Complete in Duplicate) / This Permit Expires 1 Year From Date Issued Date Issued __ __1'�7__ =d 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.......1442---But-r-0 Owner's Name--------------------------------•-•---- Daniel and Coneepsion--Vigil Phone..HQ. 5-7957 Address-----•---------------------------------------------- -442--SutrQ ----------•-------------------------------•---•-••-----•---------------------------------- Contractor's Name-------1}E�- ------ _Ept_i-.-C--Tank SerV CES Inc. ------ •_.- -•_-- Phone..H��... 3w1269 Installation will serve- Residence :] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __-!__ Number of bedrooms ___2__ Number of baths ____ Lot size ---5d_._X--- 3A--------------------------------- Water -------------------------- -- -Water Supply: Public system!E] Community system ❑ Private ❑ Depth to Water Table -_45 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No [N New Construction: Yes ;C] No ❑ FHA/VA: Yes ❑ Nom 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---------------.-_-____-.__-_-_---_----____-____. Existing No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity-•-------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line___________-_____ Exifqing Number of lines-----------------------------------Length of each line-----------------------_------Width of trench------------------------------------ Type of filter material-------------------------Depth of filter material-------------_---------Total length------------------------------------------ Seepage Pit: Distance to nearest well___1O------------DistancL_ xrrZo�_C��X ___Size: dation__ 19t______.Dista--nce to nearest lot line-___5g KI Number of pits------------ -------Lining material_ Diameter----33- ----------Depth-------- -5- --------_-_-_-_-_-.- Cesspool: _-.- Distance from nearest well_________________Distance from foundation 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):------Adding_-Filter- B_ed--to exi9t-ing--seAtic system ---------------------------- --------------------------•----- ------------------------------------•--------------------------------------------------------------------------- --------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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)-------------- ---------------- --------------------------------------(Owner and/or Contractor) By:----------- --------------------------------------------------------------------------(Title)----Qen.- Ngr•--------..-------- -- ---- (Plo+ 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.. T_ - _. __,_ r �� DATE _7--- ----I--------------------- REVIEWED BY------------------------------------------ ------------------------ ---•----------------------- DATE-------•----- -------•------- ---------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------- -- ------- ------------------------------------------------•----------------------------------------- ------------------------------------ -- ---- -- --------------------------------------------------------------------------------------------------------- ---------------- •------------------------------------------------------------------------------------------------ ----------------------------------------- --------------------------------------------------- ----------------------------------------------------------------------------------------- ------------------------------------- - ------- ----------- -- ------------------- -- ----- ------------- --------------•------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:--- -�_ -.�__�%� _- n-- - -- ------------- 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-9-2M Revised 6-'59 F.P.Co.