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FOR OFFI¢E USE: -------------- �1 3 --------- ---------------------------------- �] APPLICATION FOR SANITATION PERMIT Permit No. ..S..2.?:.` --------------------------------------- ----- -------- (Complete in Duplicate) Date Issued -- This Permit Expires 1 Year From 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..1703---E.....giaiii--- aY----t-_._gtegktsn:--_-Ca y'o% __aaptis _.Church-__--_-_- Owner's Name-------------Calvary- Baptist_-_Church__-. _ ._ ... Phone --------- ---- --------------------- Address-------------------------S.ale.•--•-•--• I I Contractor's Name..-The DAIAI-_NIG T----S_-e t.;jq.r._�_'_r&nk Service--••----------•---------------••--•--- Phone:._H0 (-3$1+1-•--- ' Slur h Installation will serve: Residents ❑' Apartment House ❑ Commercial ❑ Trailer Court ❑❑ Motel ❑ Other (� anc ua�ry g 0 jt!iretr.11 , , Number of living units: Number of bedrooms _____ __ Number of baths . of size ___.____ -_�cT.��....(. .�.......... ........... Water Supply: Public system EC Community system ❑ Private ❑ Depth To Water Table _..35ft. �, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeU Hardpan ❑, Previous Application Made: (If I yes,date____________________} No ❑ New Construction: Yes =Nc❑ FHA/VA: Yes [:] No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: t .Distance from nearest well---NIPM_Distance from foundation__.-0- ---------Material-------- C-_ArIck.................. 01 ' No. of compartments-- 2---------••---_-Size56'f X3V* 63st1.Liquid depth-------5$t!----------Capacity------$QQ---GSIS. Disposal Field: Distance from nearest weli___N®ne___Distance from foundation ..10x.. Distance to nearest lot lline.....1P.I.." Number of lines_.____I----------------- -------Length of each line----------- Q ___.__....Width of french--- Type 2_�......__..-._______.___ Type of filter material._S P_t_ G_._R�epth of filter material------- _ ----- length_..-.____�0__________________________ ` Seepage Pit: Distance to nearest well-18-ne---------Distance fromifoundation------3- Distancet.._.. to nearest'.lot Ij1p------l�t d Number of pits__1.�._____.._____Lining material------UCk=__-Size: Diameter-__--33-....______-Depth_____ m-Iain Cesspool: Distance from nearest well-________________Distance from foundation.__-----------------Lining material_______-.___________-_____._________ Size: Diameter---I----------------------------------De th_-----------_- ---------Li uid'-Ca pacify--------------------_----_gals. Privy: Distance from nearest well________________________________________ -------Distance from nearest building---------------------------------.-.__--_. ❑ Distance to nearest lot line---------------------------------------------------....---•............---••-----------------------•---------------------------------------- Remodelingand/or repairing (describe):---------------------------------------------•------------------------------------------- ---•----- •----•---•---------------•----•--------••- I -------------------------------------------------.......--------••-------------------------------------------------------------------------------------------------------------•-----------------------••--•------------------ ___a 4 _._- _________________________________________________ ---------p-------------------------------------------------•--------------------------------------------------------------------------------------------------------------------- ----------------------------------- 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. I (Signed)_The---RAY---&_--NIGHT.-Sept:Lc__Tank__5er_�ice--- (moi+ �UContractor) - ------------ - -- ----- ------------------ B (Tiiifle)--------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relat' o wells, buildin , etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ �j ---------------------------------------------•---•----•------- DATE---1_2_rn31----�---Z—---------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------- DATE---------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE........ -------•----------------------------- --...-- Altterations and/or recommendations----------------------------- -------_------ ............._..--....._...---•--. ------------•••-----•••--------------••------•--------• ----•-------------- . t •► I................................ -------------- --------------------------------------------------------•- -•-•---- •--------------------•----------- -------------------,-. ....... t .. ------------------------------- -----------------------;---------- ------- --- -- -------•-••-- FINAL INSPECTION BY:...... ..,_ ..0 .-S--------------------- Date----}- --- ` ------ .._------------------------------------- SAN - .SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak STreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS