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l� APPLICATION FOR SANITATION PERMIT, Permit No. (Complete in Duplicate) Date Issued pplication 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________2228---Turnpike Road. .. Stokton - - Owner's Name----------Cha S_,___SantLt---------------------=----•I---------------------------------- ------------------------------------------- Phone-----•---------------_-•-------•---- Address--------------------------1.73-6---Be_rke_IEy---AVP__,---------------------------------------------------------------------------------------------------------- ------------------------- Contractor's Name--------------DAY.__s&---NIGHT---SPTC---- ANK-_SERVT�E------------------------------------- Phone---x0__27046-------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ - Motel ❑ Other ❑ Apt . Number of living units: _4____ Number of bedrooms __._ _ Number of baths __4___ Lot size ___N-115-1----X1571...________Court ------------ Water Supply:' Public system'® Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ AdobeU Hardpan ❑ Previous Application Made: Yes ENo ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ Suprjementary- TYPE:OF INSTALLATION AND SPECIFICATIONS- # Drain, I (No septic tank or'cesspool permitted if public sewer .is available within 200 feet.) } Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material------------------------------------------------- Mist ing _____.______._. ________.___________..______- Misting No.1of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity--•-------------------- Disposal Field: Distance from nearest well---Nohe-_:.Distance from foundation----3._rJt--------Distance to nearest lot line_____1Q�___. E©ixting ► Number of lines''_._�-,=_____`"_______________Length of each line_____201______________-Width of trench_____24°.. & Add Type of filter matenal-----ZbEk--------Depth of filter ma+erial----1811_____�Total length----------2Q�______�tf--------- Seepage Pit: Distance to nearest well,-NoIIe---------Distance from foundation_......l5 Distance to nearest lot line- _____ l��_._ EH* ting &Number of pits--------1.________--'Lining material_-._RQCk-------Size: Diameter----- _._...___Depth_-..___� -t----------------- CA4dol: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------- ❑ Size: Diameter--- ------'------ ------ ------Depth----------------------------- ---------------------Liquid Capacity------------ ---------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building__________.___________________________- ❑ Distance to nearest lot,line------ -------------------------------------------------------------------------------------------------------------------------------------- .�r..,.v may". _• Ia•' -. .. v - - -- - Remodeling and%or repairing(de`ssc�ibe)�----=--- -----------------------------------------------------------•----•---- ---•-- - ---------------------=-----------==_------�--=-"=`' .� ---------------•-•----------------------------------------------------'--•--------------------------------------,------------------------------------------------------------------------------------------------------------ ---------------------------=------------------------------------------------------------------------------------------------------------------------------------------------•---------=------------------------------------- . I hereby certify that 1-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 Joa uin Local Health district. DAY & NIGHT. SEPTIC TANK SERVIC (Signed)--- --------------------------------------------------------------------------------- ------ ---- ---- -j0Q6i �aY - Contractor) .--. _ 13 -- - --- - --------- ---(Title) ` Y= ------------------- ----------------------------- ------------------------------------ (Plot plan, showing size of lot, location of system in relation wells,`buildings tc., can be placed on reverse side). FOR DEP RTMENT USE ONLY i APPLICATION ACCEPTED BY---------------------- -- ------- - --------------------------------------- DATE---------------------- r-- REVIEWED BY------------------ ------------------------- --- - ---------- DATE - =----=--- --- ----------------- ---- - - ---- -- -- -- BUILDING PERMIT ISSUED------------------------------- - = DATE Alterations and/or recommendations------------------ --------- ---------------------------------------------------------------------------- ......jt-•--------•--------------------------- ______________----___._._.___ ________ ---------------------------------------------------- _ __-_______`--___.__--_ ____________-___ ________-___________--_-- _ ____ ______ _ ____ ---- -------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.------ - s -!_ _'-_-__-- ___y -- _ - -- 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 1-57 F.P.CO.