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FO�OFF�E SSEf f � ,. �. ------------------ -- P _ _------------------ APPLICATION FOR SANITATION PERMIT Permit No. . -_-__._T...1.G ----------- --------- ----------------- --- (Complete in Duplicate) . ------------ -------------- -------------•----- --- This Permit Expires 1 Year From Date Issued Date Issued _A!_..// 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 No. 549. JOB ADDRESS AND LOCATION........... 4'+ -E. Handing_Wa-y.R-}•-_S o ckt�n- Owner's Name----------------------------- ....._Mr. R T1nninR ------- Phone .. Address--------------- Same Contractor's Name-.The DAY & NIGHT Septic Tank Service , ----------------------------------------............................. phonetQ•_&n3.841_-_•__._ Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-I___ Number of bedrooms __...Number of baths -------- Lot size ---------------------------- at Water Supply: Public systemX❑ Community system ❑ Private ❑ Depth to Water Table 6Qr ft. } Character of soil io a depth of 3 feet: Sand ❑ Gravel ❑ f Sandy Loam ❑ Clay Loam ❑ Clay [3 Adobeg] 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-----------------Distance from foundation.........-----------Material,-----....-.----_--...-_ ff Dissppossal Field is Distance from ri m near st well------------- Dstance from foundation.................... uid depth------------.Distnce to Weare t lot line_................. � ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench...------.-_•---------•.__-------- Type of filter material-------------------------Dept-of,filter material-----------------------Total length-----------------------------.-_-_•_-__-• Seepage Pit: Distance to nearest well-Norg------ Dista' from o ndation--.... r ZQ.--------Distan =to nearest lot linet. ............ - it pg Number of pits.)-----------------Lining mater al---R-L?-Ck- -Size: Diameter-_ . -� pth---------2-�................. a8esspoor Distance from nearest well-----------------Dist nce foundation--------------------Lining material------------------------------------- El .--.-------.- -_------.--._- . Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity ._gets. 41 Privy: Distance from nearest well----------------'_--- _-------.-------Distance from nearest building------------------------------------------ 11 Distance to nearest lot line-----------•---------- Remodeling and/or repairing (describe):- -------------------•---------•-------------------•--------------------•--- ........ .... -------------------------------- ----- ---• - ---------------- -------------------------------------------------------------------------••----_-.-•-_-.-.-.-_-___-.---..--__-.-..._.____.-..-.----___._._....--..-----___-_-..-__---.__--.-----__........__-._-_----_---..-.----_--..-_------ --• k -•----------- --_--_---------_---•--•_----------------•-----•---- ----•--•••----------•----------------•-•----------------------------------------•------------------••-------'•----------•---------•-""--------- I hereby certify that I have prepared this application and-'that the work will be done in accordance with San Joaquin County K ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. # TUC -T-01-'S--G ------. - -------------•---------------------- ----•----------------------(� B y:................................................. Contractor) -- --------..•.------------------------••--------•-•-----=------...-•----------•-(Title)-...-------•-- --•--------------�- -•-- - .{Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). OR DE ARTMENT USE ONLY q APPLICATION ACCEPTED BY ------•-----------•-•-- DATE------ REVIEWEDBY--------------------- -•------ -- -------•--------------------- ------------------------------------••--------------------• DATE BUILDING PERMIT ISSUED---- --------•---- ------ --� D TE Alterations and/or recommendations:.- 1 ---- - -------------------------- FINAL INSPECTION - GJ Date----- u - r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California REVISED B-99 21A B-61 ATLAS If f � 1