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APPLICATION FOR SANITATION PERMIT Permit No. d. _93- {Complete in Duplicate) Date Issued / �..,. : A r v w f qr 3-- 3 oo-d H 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. Lot 66 Tract 59' Unit 2 East off Priest Lane: JOB ADDRESS AND LOCATION_-__-_On__JanetRc�.. a_tterm ou -__QGalin Rd:.-_ French__ Owner's Name 0t,t_Q' T RfC - ------ Sh e .:FC HOrnes tes)------------------------ ---------- -- Phone HO 2---.0970 Address-----_-----------•-- -----47-9 ----French--- -amR•-------•-----------------------------•--------------------------------•--------------------------------- Contractor's Name,-___----- AY___&__NIGHT SEPTIC__TANK SERVICE -------------------------------------------- --------------- Phone.-- AQ_..Z!n704_6---- Installation will serve: Residence$,Z Apartment }~louse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-1-- Number of bedrooms __2--- Number of baths ---1__ Lot size ------191}_1----X-__' 5Y-------------------------- Water Supply: Public system ❑ Community system ❑ Privatex{ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam [U Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes [$ No ❑ FHA/VA: Yes ❑ No EX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__50 I---_Distance from foundation-----)„-!-------Material------CC----Brick-__------------- xx No. of compartments----2-------------------Size-5 1! 6«YC---.---Liquid depth--58«----------------Capacity_-• QQ__GaS Disposal Field: Distance from nearest welt__---�QDistant from ou dation_____ -------Distance to nearest lot line------5 -___ _ Ax Number of lines--------3---_------------------Length of each line-_-�_�_�.4Q'-��_Width of trench----------2411.______._._-_ N Type of filter material$.ept-o-._Rk-Depth of filter material---_18i------------ length--------12C--------- --------___-____ Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------:------Distance to nearest [of line-------.------__ ❑ Number of pits-----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------------------- . Cesspool. Distance from nearest well-----------------Distance from foundation-------------`.-.--.Lining material--------- ---------.-----------------. ❑ Size: Diameter Depth '----------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_------.--------------___--_--.-____.__-_+ ❑ Distance to nearest lot Eine - Remodeling and/or repairing (describe)=--------------------------------------------------------------------------------------- ----------------------------------•------------------------------ --------------------------------------------------------•----------------------- --------------------------------------------------•----------------------------------------------- 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. RAY & NIGHT SEPTIC TANK SERVICE (Signed) ----Lw ---------------------------- ----{C�� Contractor) -- -•-------- --- --- -----13y:.---- ----- -- --• -- ------------------------------ n '--- - - -------(Title)------ - -- --- ------------ --- ---- -------------------- {Plot plan, showing size of lot; location of system in.relalls, building etc., can be placed on reverse side). FOR btPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------------------------------------------•----------------------- DATE------------------- - - - - REVIEWEDBY---------------------------------------------- ---- ------ --- --- --- --------------------------- DATE-------1 --^ BUILDING PERMIT ISSUEDDATE------------ -- ------ -- -- ------- ----------- Alterations and/or recommendations--------------------------- - ---------------------- --------------------------- --- - •--------•-------•------------------------------------------------------------------------------------------------------ -------------- •-------- ------------------------------------------------------------------------------------------------------- -------------------------------•------------------------------ ----------------------•-------- I FINAL INSPECTION BY:.--'/?----- -- ------------ ------------------------ Date-------f 2-e-'--j-.. _CSary 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 E5-9-2M . Revised 1.57 F.P.CO.