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1-UKUH-l_t U5L: '— --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) ---------------------- -------- - This Permit Expires i Year From Date lssued Date Issued ........._._.___...____ Application is hereby made to the San Joaquin Local Health District for a permit to const uct and install the work herein described. This application is made in compliance with County Ordinance No. 549. V F JOB ADDRESS AND LOCATION...._____5l6 So, Wagner ! Stockton - Owner's Name. T�?4Ir1 S_.F a 2.@T ------------•--:-•-----n------•-- Phone---- 0..41_97.; Address............................ ; Contractor's Name--------The-_DAY &. NIGHT Septi------------------------------nService phone._..Ha•-638 -1 -- ---------------------------------- Installation will serve: Residence]a '*Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __],.__ Number of bedrooms A__- Number of baths ...1. Lot.size ...7.51...X154[ Water Supply: Public.system MxCommunity system El Private El Depth to Water Table'-'--6Q ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel-.❑, Sandy Loam ❑ Clay Loam El Clay ❑ Adobe MI Hardpan ❑ Previous Application Made: (If yes,date--------------!�._No-i3 New Construction: Yes ❑ -No K FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND.SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 2DO feet.) Septic Tank: Distance from nearest well_________________Distance from foundation___..._.__--.--___.Material____.._.___-.______........__.. ..............•-- EStng No. of compartments: _Size_----------•------------•-------Liquid depth ----Capacity Disposal Field: Distance from nearest well----NQ -e-Distance from foundation.....[Q...----.Distance to nearest lot ine....30 ------ [� Number of lines______-.:=___Z'"----- --------- --Length of each line_--_-___40_____....'_= Width of trench.__. 2411 Type of filter material._. apt___Rk_Depth of filter material--------19«__'....Total length........ 4Q ....................... i F�. Seepage Pit: Distance to nearest well---None-------Distance from foundation___-1�-t-: Distance to nearest lot lin _-_.-__-_30t Number of its...___ ##33.'.' ---,Depth�...= Lining material BQCk_..Size: Diamete-r_ • 33..---.Depth--------2-.5---....--•---...---• f Cesspool: Distance from nearest well------------_____Distance from foundation--------------------.Lining material-.___-____---__ Size: Diameter-----------------------------------------Depth---------- -------------------------------- "" Li uid Capacity .,i�..11•.�.. q -----------•----------------gals. �—Privy: Distance from nearest well~_______________________________________________Distance from nearest building1. -•-----------------------•"•------- ❑ Distance to nearest lot line : --L"- -------------------------- -------------.._.---------------Remodeling ---- ---and/or repairing describe ----installin,g_..dra.i.naga---only--------- •--------�---------------•-------., ---- ...------- I . fi :..._ . -------- re.drrra_�1 --------------------------------------------------- k •---------------------- hereby certify that I have prepared this application and that the work will be done'in acco (iance.with Sar' Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District'- ( ig )• i- S' reed The__AAY.._$ __NI("x .-___.-:.Sept.lc._T. __S�;xY�c4------------------------------------ ( �r Contractor) By:................--------------------------------------------_----------------- Title �- ----------- {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �- FOR D PARTMIENT USE ONLY APPLICATION ACCEPTED BY----- ------------------- - -------------------------- --- - DATE....------ - --- Cr✓ - - REVIEWED BY ----------- - -------------------- DATE_---------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- ----- DATE----- F A` lter tions and r r ommend tions:.. — , : ----------------••----- 6• ---.---- ...� i j ----------------- -----------------------------------------------------------------•------•- /fC�. "` . ------------ ------------------ -- --------------............... - FINAL INSPECTION BY:_- - -.`. �� ------- Date------- ----------� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 12,4 Sycamore Street 205 West 9th Street ' Stockton,California Lodi,California Manteca,California Tracy,California tS 9 REVISED 8-89 2M 9-61 AYLAS /