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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) IK!15�Date Issued -- 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. E),71— 2-to —IL JOB ADDRESS AND LOCATION-------------------------------- Owner's of Front & Harrison Sts: Linden Owner's Name-------------- --------------------------------------------------------------- ---------------------M------------------- Phone------------•------------------ Address------------------- • -Q� BDX__633_9-- Li d—e-n---------------- Contractor's Name------------'-----Day---&--Nigh----'S--BA-t- C--- ank---Service-------=-------------------------- Phone----Hq--------27oLF6- Installation will serve: Residence =Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -----1 Number of bedrooms _2___ Number of baths ---1-- Lot size --3.QQ...... ---20Qf________________________ Water Supply: Public system$] Community system ❑ Private ❑ Depth to Water Table _40tft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan ❑ Previous Application Made: Yes ❑ No E New Construction: Yes ❑ Noig FHA/VA: Yes ❑ No E TYPE,OF INSTALLATION AND SPECIFICATIONS: ti , (No` septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: -ZiDistance from nearest well:`_ .____A,� tance:from ,foundation- ---------------.Mater•sal_-''_______._________________________-_---__--. Eilsting No. of compartments---------- ---- e--------------------- -------- q p. ----- - Capacity I � Li uid de th___________'___ _ _ Ca acit � Disposal Meld: Distance from nearest wefi-----------`_f__-Distance from foundation--------------------Distance to nearest lot line,------------- misting Number of lues----------------.----,--- Length of each line---------------- of trench----------------------------___-� Type of filter ,material-------------------------Depth of filter material-_----------------.Total length-------------------------_------•- -_--�+ Seepage Pit: Distance to a Srest we°l!N)C&B'.___.____Distance from _f_o-undation-_ .2Qt.__._..Distance to nearest lot €ine_---10�----sNumber ofpit h'_-1------Lining R ---Size: Diameter----33------------Depth--------2s1--------------- Cesspool: + Distance from nearest well from foundation_____________.____.Lining materiaL_-----------------------------_--4 ❑ Size: Diameter-----�------------------------ ° Depth---------------------------------------------:-----Liquid Capacity----------------------------gals Privy: Distance from nearest well-------------------------------------------------- from nearest building----------------------------------------- Distance-to -Distance-to nearest lot lire---------------------------------------------------------------------' Remodeling and or 'repairing describe)_-------------*_ S u ementer-- Drain& e'----- --------- --- -- ---------- --- ------------------------------------------------------------------------------ --- L? -----------------------------------------------------••--------•-=---------..._.__-._ --------------•--------------•----------------•------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. S� ned DAY & NIGHT SEPTIC T A ERVXCE 9 } ----------------------------------------------------------- --- ---- - - -- - --- - �� Contractor) BY= - ----- �"` == Tit[e)----��==------------------------------- a (Plot plan, showing size of lot, location of system i lation to wells, buil ' s, etc., can be placed on reverse side). OR DEPARTMENT U ONLY _ G APPLICATION ACCEPTED BY- --------- _ BATE - Is ----------*REVIEWED PERMIT ISSUEDr------------------- - DATE i-- -- L.i Y-------------------------------------------- - ---- ------------------------- --------------- DATE- - -- -- ---------- Alterations and/or recommendations.----------------------------------------------------------------------------------- ..----•----•-•------••------------------------------------------------ -------------- -----•---------------------------------------------•---••------------------ ---------------------------------------------------------------------------------------------------------•--------------------_----------------- - --------------------••- - F€NAL INSPECTION BY:.----- - ------ Date------ SAN JOAQUIN LOCAL` HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California% Manteca, California Tracy, California ES---9-2M , Revised 1-57 F-P.CO. F