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FOR OFFICE USE: Permit No.c � :cam. - 1 - - APPLICATION F'OR° SANITATION PERMIT v - ------------------------------------- (Complete in Duplicate) Date Issued � � This Permit Expires 1 Year From Date Issued l ( [may _0.� 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. ��..TVT corner Qq q-L' til- . "-u x1�--i'c— " _ ----- x _.Ii _.JUB.ADDRESS AND LOCATION-------8t.,5-----Bax-198----------stowdan-s 463-9308 ----- -----FTA __BAKtIII ------------------------------------- --------------- --------------- ---------- ._� Phone------------------------------------ 'Address ••----- _-- owarcl andUnci neRds 4-__�l�nion_Rd,�}__Rt Q-_5--Box-_1�8_ ----Etockton-__•------------------------••-- ------------ The DAY GHT Septic Tank Service l�66.�38l�1 Cantractor's, Name-------------------------------------------------- ----- - -- --- Phone Installation will serve: Residence IMApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _- ___ Number of bedrooms __Q__._ Number of baths ---2___ Lot size ____-.-Acera. ------------------ Weter Supply: Public system ❑ C 8mmunity system ❑ Private [K Depth to Water Table -------- ft. `..Character of soil to a depth of 3 feet . Sand [j Gravel ❑ Sandy Loam El Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ , ". .Previous Application Made: (If yes,date.- ) No F1 New Construction: Yes E] No ElFHA/VA: Yes E] No ❑�� € f.• t SYPE OF INSTALLATION AND SPECIFICATIONS: `1» SW [No septic tank or cesspool permitted if public sewer is available within 200 feet.) I `�_Se tic Tank: Distance from nearest well_________________Distance from foundation__._________--____.Material------------_...---_.____.--______--.____.__-1 p r ' iquid depth-------------- --------Capacity Y - EJUSting No. of compartments--------------------------Size--------------------- L 1 Disposal Field: Distance from nearest well...7.J5.�------Distance from foundation..-.29�__-.-----Distance to nearest lot lin_e___ �.___.. Ex� g I f t111 Number of lines---1---------------- --------Length of each line____- �.0t_-------------.Width of trench--------------- -----`-----------'. :.'._&'ADD Type of filter nraterial__arePt1 --Rk-Depth of filter material--------19"_........Total length----_.___-___llr---_------ ` I- a L =See a e Pit: Distance to nearest well__________ ___________Distance from foundation_ -_-____.___ to nearest lot line----------------- Distance A p..9 '. 5 .. i ---Linin p --- - r El ----------Dumber of pits.-- g material size: Diameter Det - �.. , Cess ool: Distance from nearest well-----------____ _Distance from foundation--------------------Lining material__._._.___. ____ ------ p ----- Depth------ ------------- --- --- ---- Liquid Capacity---- gals. - --a-❑ �. Size: Diameter- -=--------- ----------- _____________________Distance from nearest building :Privy: Distance from nearest well ------------------- ---------- Distance... �. 5to nearest lot line----- ------------ -------------- ------------ --- .",`-;Remodeling and/or repairing (describe):_______ ________ ______ _____ t -` ----- ------ --------------- ------------$uPTLEMENWa__P N----------- ------------ --- R -___._ __. ..... . ... ...... p -------------------------------- ------------------------ 1 ______ ___ ______________________________ __ ___________ ____________ _____ __ ____ _. _ -.1 hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County . 'ordinances, State laws, r rules and regulations of the San Joaquin Local Health District. Contractor] `[Slgried) '} ----------------- -------------------- ----- ----- z.. _ ------------------------------------------ - --- -- -- si;t�-rlc r c� - (Title)-- - --- -- -- --- (Plot`plen sh wng`sze`ryof lot,�foeatirfri bf system in relation wells, buildings, tc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY ------------------- APPLICATION ACCEPTED BY_ ------------------ -------------------- ------- --------- DATE- - "" R?VIEWED BY------------------------- ----------- --------------- ------------ ------------------- DATE--------------------- . ;.. BUILDING PERMIT ISSUED----------- '------------------------- --------------------------- ------------- ----------------- DATE----------------------------- -------- -------- ------------ .. -------------------•---------------------- Alterations and/or recommendations:-_____-.._. ---------- ----•-----••------------- -------------------- M1 ------- ----- -- ,f �. ._ _ •- ------------------- ------------------------ . . - --------------------------- -------------- - --- ............ --- ----- --- ---------- - -- - --- ------- --------- FINAL INSPECTION BY:....- ----- ----- Date ` -�-~---- _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1501 E.Haxellor Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r Stockton,YCalifornia Lodi,California Manteca,California Tracy,California