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FOR OFFICE USE: --------------------------------------- ----------------- ------------- ---------------- ------------------- ---------•-------.--_.---.--_----_--------- ----------_.--_----.- APPLICATION FOR SANITATION PERMIT Permit No. ..,/..'��_�. ------------------- •-•---- (Complete in Duplicate) S Date Issued ... -----.--- This Permit Expires 1 Year From Date Issued ..../... `Z Application is hereby made to the San Joaquin Local-Health District for a permit to construct and insfa!I � he work hereinscribed. This application is made in compliance with County Ordinance No. 49, -�+ eft=- „ �S6'�. s• . N� c--h o. of f1", St* vim" JOB ADDRESS AND LOCATION......Hi�110 x--Heights_._ w� -- end...Q Owner's Name---------- .....Co---------------------------------------- Address ------- ----- ----------------------- Address---------_--------- - �-----•---------------------------------.. Phone--H---O•----•2------0--- a@? W•• 5th---��--t• Contractor's Name,.-The .DAY &- NIGHT Septic Tank Svc. Phone.HO 6- $?+1 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----I Number of bedrooms _3-_-_ Number of baths __-!__ Lot size --------1QQt•_X-• .OQ Water Supply: Public system) Community system ❑ Private ❑ Depth to Water Table -------- ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam MX Clay Loam ❑ Clay ❑ Adobta❑ Hardpan❑ Previous Application Made: {If yes;date------ --------- No ❑ New Construction: Yes$ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest'well.__�f331it�--Distance from foundation_-.-�.Qt' y` `"CC--Brick_ - ---•---.Material.... ............... ... No. of compartment;...21......-••--•-----._Size_5_21._xa&1x63rtLiquid depth-----��--:------------Capacity---8QQ._.0als, - Disposal Field: Distance from near�e-st well None.-Distance from foundati75ti...10-t-,ss nce to'nearest lot line------ t �X Number of lines) ----------------- Length of each line----_- ._ ._-� - 13----. id h of trench......XUXX 2 .. -� Type of filter materialept R ?epth of filter material----------------------- length --------1�Qt-------------------- --- �n "1 Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to-nearest lot line----.--.......... ElNumber of pits----------------------Lining material-----------------------Size: Diameter--------_----------- Depth----.---------------------------- r(j Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material__...._.--•.......................... ❑ Size: Diameter------------------ ----°---- ----------Depth----------------------------------------------------Liquid Capacity.---------------------------gals. F Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------------------- Distance ---_------_-__._.-___---___------_--.-Distance to nearest lot line------------------------------------------ f -t Remodeling and/or repairing describe :k-----•-------------------------------------------------------------------•-------------...-----.._..----------....:'---•---. ------- ---•------------- --•-----------•------------------•-•-------•----• --------------------------------------------------------------••------.-------------------------•------•--------------------------------------•.-.---------......I'll-----------------•---••----..------------ a • -------------------------- ------------------------------------------------------------------------------•-•--••-------•----------------.._...--•-•---------•-•---••-------•------------------------- ------- I hereby certify that I have prepared this application and that he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaq n Local Health District. (Signed)•-The_ DAY---& NIGHT Septic Tank Serv!i--e Contractor -- ------------ -- --------------BY= - (Plot ) plan, showing size of lot, location of system in relation to ells, buildings, c., can be placed on reverse side). FOR DPAR MENT USE ONLY .. APPLICATION ACCEPTED BY---- ------------------------------------------------------------fi C,--- DATE--------• ------------------ �..' REVIEWED BY DATE BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE--------.-..----------------------- ..... Alterations and/or recommendations:---_--------------- --------------_--------- _ = -..,...._...•••------------------••----•------......•-------------------...._... -------------------------------------1_11------------------------- ---------------------------•------------------------------------•------- ---------------------------------------- -----------•------------•------•--- 1 a FINAL INSPEC •- ------ -------------- -------- Date------�w -- -.6 .r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strut 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISED 8.59 sM 5-61 ATLAS .d J