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50, 1Z OFFICE USE: --- ------ .1 L- APPLICATION FOR SANITATION PERMIT Permit No. ...1... ... .. . ; - --------------------- ------ (Complete in Duplicate) s' This Permit Expires 1 Year From Date Issued Date Issued .._.__1.;7.I..Gt.�� 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 Ng. 549. ;{ I s q 2 7 -9-. r4 A-�,-.r,q-;? LnJ ' 01 of "M,: St. JOB ADDRESS AND LOCATION-3 RImar--He.i.ghtS- _---We.st___end---Df---- -Cho_of--- •--La ap3.-_�� -..__.. Owner's Name. P ._jj2 _.. Q-R-------------------------------------------------------•-------•------------- PhoneJJQ---2-nQ715.--....... Address-----•-----•.............864W: __St-* Contractor's Name------The---D-AY.'&-.15IQHT------septic--Talk---Svc_,-----------------------------------•--. Phone Q... - 81 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._.... Number of bedrooms 3__- Number of baths ---1. Lot size .....3:001..5---100!----------------------- Water Supply: Public system 19 Community system ❑t Private ❑ Depth to Water Table ________ ft. Character of soil +o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [2jx Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,-date 7------------------- No ❑ New Construction: Yes ME No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or-cesspool permitted if public sewer is available within 200 feet.) Septic Tank: h Distance ._w7Nine__Dze 6e_ 6ti �3riiLln•u1Qde the �ral �_CC-,B 'i Noof compartmen$ 2_ Q... �.....5:= Disposal Field: Distance from nearesL�t well----NOIIB.-Deng�h of each line e from a��t.s tion �QE_�:Di+t ncofttre Chest 1o�.4'e_____------ 5`______ r� xx Number.of lines------- Type,of filter materiah7.e_P_t. Rk_Depth of filter material.---- Total length....... .. ..._ls`�� �p Seepage Pit: '' Distance to nearest well________________1_____Distance from foundation--------------------Distance to nearest lot line____.___.__.___.- N ❑ Number'of pits----------------------Lining material-----------------------Size: Diameter---•---------------------Depth........................--------- Cesspool: Distance from nearest well_---- :`-------Distance from foundation---_---------------_Luling material------------.------------------------ I, ❑ Size: Diameter---------------------------- ------Depth-----------•----••---------------------- Liquid Capacity gals. Privy: Distance from nearest well._---_._�--------------------------------------Distance from nearest building------------------------------------------ 13 distance to nearest lot line }------------ -----------------------------------------------------==---------•-----•------•-------••--------------------------• i Remodelingand/or repairing (describe)-------------------------------------------------------•----------------------------------------..._....----------•--•-----•------•---------...........---- t a x Y i _________________----------------------------------------__________-------------------------__.........----------------------------------------------------------------------------.___....___-_-_-___--___-_-____.__..___.__-. I hereby certify that I have prepared this application and that the work will be done in accordance with Sari Joaquin County ordinances, State laws, and rules and regulations of the-San Joaquin Local Health District. The DAY & NIGHT Set .._. - (O� KContractor) (Signed)....----h --- � ----- � i_�..-Task ��ry Br--------------------------------------------------------------------------••----------------- (r+le)=�------------------------------------------------ � . _ (Pbtplen,_showiing size of lot,eloc��tion.of system in relation to we , buildings,et ., can be placed on reverse side). FOR DEPARTM T USE ONUIV r:. APPLICATION ACCEPTED BY-------------------------- ------------------------ -- --- -------'�T�D J('�_G--------- DATE:-------- BY----------•------------------------------ ------------------------' =----••. DATE----------••----------------------------------------------- BUILDING PERMIT ISSUED ---- •---•-------------------------- DATE-----------------------------------... I Alterations and/or recommend'ations-----------------•-------------- -----------------------------------------•--•---------••---------------------•-------•-----------•---------•----------- r ---•-•-•---------------• --------•---------------------- I - ------------ ------------- _..... ........ FINAL INSPEC - ------------ - ----- - Date--------�r_.y_ ..Q._��.------------------------• , SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 285 West 9th Street Stockton,California Lodir California Manteca,California Tracy,California E8 9 REVISED 8.54 2M 6.61 ATLAS