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FUKUtTlu ubt: ----------------- --------------------------------------- ---- ------- ---------------- ------------------------------------------------------------------- -- -------------------- - APPLICATION FOR SANITATION PERMIT Permit No. ... (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued 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. 2nd place east of Gonzales Grocery JOB ADDRESS AND LOCATIO$ .,�..-1__. ®x...g4 $--_T=racy_- s _Larch R©adeastofCorra2_ HRd.___ -._ -_- ____ ] Owner's Name----------------------------- A1ber.t_a.113.V------------------------------------------------...-----•------•----------------- Phone.TE--51373-------.._. Address.............. Same Contractor's Name.....!he..)DAY.-A---X—TQ ...$.ePti0_.`8.nk___ervice.................................. Phone.._Z0...63$11....... Installation will serve: Residence (I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: _2____ Number of bedrooms .2---- Number of baths .__._ Lot size ./_-..__ a_cr'e. . Water SuppEy: Public system C] Community system ElPrivate)M Depth to Water Table(a._-_- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobea Hardpan ❑ Previous Application Made: (If yes,date---------------__] No EK New Construction: Yes ❑ No:u FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.................Distance:from foundation------------.-------Material................................................. E-1 stin.g No. of compartments------- ------------------Size-------- ------------------- Liquid depth ------------------- Capacity_..................... Disposal Field: Distance from nearest well Ot--.--.-_Distance from foundation___-1'ff_477�....Distance to nearest lot line...... t...._. j,xi0t j ng Number oflines---------l----------------------Length of each line-----------imI--------width of trench.---_-2)+7__------._...— & Aad Type of filter material..s fl} __.RkDepth of filter material----1$...............Total length---------- �'_.../A,�_-..._- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line................. ❑ Number of pits----------------------Lining material.......................Size: Diameter.----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material----------------------............... p Size: Diameter------------------_--------- ------Depth----------_---•--_•--------•-•---------------------Liquid Capacity........_--•------•----•---gals` Privy: Distance from nearest well----------------------------------------- -----.-Distance from nearest building.......................................... ❑ Distance to nearest lot line---------------•--••--•----•-----------------------------...........------------...._-...--------------•--------•------...- Remodeling and/or repairing (describe)-------------------------------------- ---------•-•--•----------------------------- ------------------------------------••--.-------....-.-•----------------SUFFI J ME y---DR��It A-GE-------/.O- ------------------------------------------------------------•----------------------------------•-•---------------------------------------------------------------------------------•--------••----•------- ------------------- 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. (Signed] The__DAY & NIGHT Septic S rr �- -- -- ---------* * = 't * - i n�Contractor] By:.......................................................... -------------------•- ---- --- -- ITi+Ie)---------- ----------------------------------------------------- (Plot plan, showing size of lot, location of system in rela to wells, buildi s, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ------------------ ............ DATE -- ----- REVIEWEDBY....----•--------------------------------------------------- DATE ---------------•----- BUILDING PERMIT ISSUED--- ------------- DATE.------ -- •-- --•---•------. ------------------------ Alterations and/or recommendations: ----------------------------------------------------------------------------- ------------------•-------------------.._..---------- -------------------•--....----------------._.-.-----------•---- = -------------------------------------------------------•-----------------....-------••-•----•--------•-----•----------------•----------•--••------- ---------------------------------------•-•------.-._.......... ---------------------------------------------------------------------------------------------------------._.------------------------------------------------- ---------------------------------.....................•-----•------ ----- --------------- ------•----------- •--•------------------•-----••-------------------------------------------------------__------------------- --------------------------- ---...-•----------•------------- --------------------- FINAL INSPECTION BY:- -•---------------------------------------------------- Date----------- ............................. 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 E6 9 REVIBEO B-89 2M 5-61 ATLAS