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FOR OFF 151=: • _ s. ------------------J----- ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..�. -------------------------------------------------- (Complete in Duplicate) ---.----.--- This Permit Expires 1 Year From Date Issued Date Issued ..-. � . _.fa3 Application is hereby made to the Sen 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. 1 mile north of Farmington ZSsle© �- JOB ADDRESS AND LOCATION-----Gr_ove.S----A08d..pr49--1QQ---= E. Q - QS - I Qua Ra------.... Owner's Name....Wl. J. Brennan . � � 7 12 ------------- ------------ -----------. -------------------------•-------.. ---------------------------------------- S Address--------------------- A--QA-Q. -- Contractor's Name........ D.AY & Septic Tank Service HO 63841 -------------------------------------------.-. Phone.---. -------- ------------------ # Installation will serve: Residence �t Apartment House ❑ Commercial E] Trailer Court [:] Motel ❑ Other & Trailer Number of living units: -_I- Number of bedrooms 1---- Number of baths A--- Lot size -------15--- _cr.es_...j=_ah8_;'d--_ Water Supply: Public system ❑ Community system ❑ Private PP Depth To Water Table .--6-oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [N Hardpan ❑ Previous Application Made: Ilf yes,date--------------------I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest weil_-3-0 _-.-_ Distance from foundation-----19t r------Ma aerial----CC_-BrAck- ------------------ � Zx No. of compartments-----2------------------Si,e56".x3_6"x.63_--_Liquid de th-_56-_.---.---------Ca aci $00 Gals Disposal Field: Distance from nearest well--3001...Distance from foundation...101---------Distance to nearest lot line.=-_�.�-__.ffla � l Number of lines------1--------------------------Length of each line-------4--._------._----_ Width of trench------------_------------------•--- a Type of filter mate rial__►Sept-.-_RkDepth of filter material------19---------Total length---------------1+0_-_-------_-_------- C Seepage Pit: Distance to nearest well----3 t------Distance from foundation----.....1Q1_..D' tante to nearest lot lits--..0t y a � Number of pits----1--_---_------Lining material__Avzk-------.Size: Diameter-------------Depth------2.5--------------------- Cesspool: Distance from nearest well-----------------Distance from foundation----------.--------.Lining material------------------------------------- EJ 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):------------I---B/R_.trallar. ...................•------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- • ---------------------------------------------------------------•-•--------•--------------------------------•------------------------ ------._....---------------- -••------•--------•------------------- ------ --------------------------------------•----------------•-- ----------••--------•-------------------------------------•----------------•---------------•---------------•-----------•-----•----------- 1 hereby certify that I have prepared this application a that t work will a done in accordance with San Joaquin County o ordinances, State laws, and rules and regulations of the S n oaquin o al Hes h District. [SI ned The DAY---& .NIGHT Septic--Tank--__ 2 i e Con#rector 03 'e } ...... ... . . - -- -- - ---- ----- ---- -- ---- --- ------ •-----(� 1 By:--------------------------------------------------------- (r+le}._- ---------------------------------• ---- - ------ ------ (Plot plan, showing size of lot, location of system in relation t ells, buildings, etc. can be placed on reverse side). FOR DEPAR i:NT USE ONLY r �_,� APPLICATION ACCEPTED BY-------------- ----- --�� ---- -------------------------•---••---•-------..__. DATE-•--�-'l--•-------•-------•--•------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------•---------------- DATE----------------•----------------------------••----•-- ---- BUILDINGPERMIT ISSUED--------------•-----------------------------------------------—---------- DATE-------------•-------.---.-----------1-1------------------- Alterations - .-- --- Alterations and/or recommendations------------------------------ ------------ ---------------------------------------------- -----•-------•---•---------•-------------------------•-•-.------ s -•--•-•---...-•------•----•--•----------------------•-------•--------------------------------------------------------------•------------------------•----.-...-..-._.-...--..--...----------•-----------•-----------------•- -----------•----- -----•------------- ---------------•-•-----•--------- -------- ----•--•----------------- ---------------------------------------------------------••------------------------•------•--•------------------ ----------------- ---- -------------------- ---------------•---- -------------------••--------------------------• •------------ -----------------------•------------•--•-------------------------------------------- FINAL INSPECTION BY:------ �/ -.Ilz ---l------------------------.-.- Date 7.�143--..------------- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sveet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracyr California ES 9 REVISED 8-59 2M 5-62 ATLAS