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- --------- --------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ��2 (Complete in Duplicate) �� a✓ 2�' ------ This permit Expires 1 Year From Date Issued Date issued 'Application is hereby made to the SanJoaquin Local Health District for a permit to construe an,/ alI�fZe work herein dese I�bsd This application is made in compliance with County Ordinance No. 549. i JOB ADDRESS AND LOCATION.....-----"21--L%---k ildrA'tri_.L @_}._-S 4CktGn------------------•-• Owner's Name. -----------FX.=k--- e.Drax-a-ea---------------------- -------------------------- ------------------- Phone..---QR---732,52........ Address =� - Contractor's Name-----`ThODAY..& NIGBT Septic Tarik SBrgieeHO Ej ,6Q Phone �....:. ....... Installation will serve: ResidenceZ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. .1--- Number of bedrooms .3--- Number of bath.'i..... Lot size _.759 X 3,5p1 ------------------ Water Supply: Public system ❑ Community system ❑ PrivateU Depth to Water Table .50_ ft. I Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe U Hardpan ❑ r � \ Previous-Application•Made:-l if yes,date_—_-. J -No [:]—New C-onstruction:.-Yes-E3--No U_FHA/.V.A: Yes-0_ No ❑ � TYPE OF INSTALLATION AND SPECIFICATIONS: p (No septic tank or cesspool permitted if public sewer is available withiw 200 feet.) �A �'jbti No. of compartments--------- ---------•----._Size------------•-• ----tf's- nui h--.Material_-.. I Septic Tank: Distance from nearest well----------------- Distance rom�foundati�iquid dept ------•---------- ---------Capacity.......... ....•--•-•--- Disposa from Distance from IEx�tling Number of I nese:}--st-�, 1�3� ®--Length of each l ne foundation =�f�----:-[--Wl idt'hCofttrench est to �llfn�e..•J-.. � 4 c�C �D� •.. Type of filter mate�lal..S_�f?:r ___Rkaepth of filter material ft lengthj_____ _____________________?Q- --__-- 1 ' V , -�-•-Seepage Pit: Distance to nearest well_____-lot-----Distance from foundation__-. 1-__.___. �� Distance to nearest lot line...... t ) ing Number of pits------t ----------Lining mate rlal_B_9-ak----------Size: Diameter.__._.33.. t esspoo : Distance from nearest well-----------------Distance from foundation.__.__________=__.Lining material____.--___..___.--____----t__....: ❑ Size Diameter------:�-----"--- l�-------Depth-------- • �� ❑ -- �..»=��-•�a". - ---------•----------------------- •--------Liquid Capacity= �-----• ----- - - gal_s., Priv Distance fro-m-nearestwell '` ------Distance from nearest.building ------ ...D.stia�n�ce-to--nearest'of . ` tine --------------� ----------------------------------- ---- Remodeling and/or re"pairing (describe)___________________------------------------ - ' k �-------------------------------------------------------- ------- _, Sap �I . lty �rtaa� . gea_ - --•-----------------•--•------------------------------- -------------------------------------------..------•-•-------------------------- I - ` hereby,certify that I have prepaied 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. (Signed)_... 1Q.DAYS&_.NIG 'I'.'._S _i ...Ta - S.ervi4e -----------------------------------(QUEN)WOfir. _ Contractor) By'--------i="...................................... ------ -- -- -- --------- (Plot plan, showing size of lot, location of system in rola to wells, buil gs, etc., can be placed on reverse side). ---- R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- .�----------•---- DATE........ C¢ - REVIEWED BY----------------_------------ - ------------------------ --- "- --------------------------------------------------------------- DATE-----------------PERMIT ISSUED-------------------------------------------------------------------------------------•-------- ------ DATE. a Alterations and/or recommendations:______----._--_.__.___._ !' ---- -----------------•----•------------------------------•- -----------•----------•------ .-•---------••---••-•----•----- 's--- --------------------------------- ------•••-------••---------•------------ -- ------1P-/t 1 FINAL INSPECTION BY:_- ---- - ---- +� ~'`—� Date--------- -----------t �--"-b------------ 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 ES 9 REVISED B-59 ZM 5-41 ATLAS