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FUKUl-Hct USE: t�- ------- -------------------------------------- - V- ----- ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..��_l..�:. (Complete in Duplicate{ Date Issued ... -- --------------------------------------- -- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 1 This application is made in compliancewith County Ordinance No. 549. i l JOB ADDRESS AND LOCATION_._._ -------I$96-_W----Ma--n_•S�rEet------------------------ -- - -----=--------------------- :LJ:L.-W�?-.�te----------•--- -------------------------------------------- Phone..MQ..4.66. .6.......... Owner's Name-------------�-:..._...-------•- E� Address............................. € -------------�a me-------------------•--------••- ------------•---•------•----•------•-•----•-•--•--•-••-----•-----••-•••••....-••••--•••--•. Contractor's Name---The---PAY...& ?_NIGHT SeptiC___Tank-Sservice �i - - ------------------------------- Phone.._.0...63-8-41.--- Installation will serve: Residence =Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._.--- Number of bedrooms -----3. Number of baths ---I. Lot size ...5Qt-------X-_IR51.......................... Water Supply: Public system [Z Community system ❑ Private ❑ Depth to Water Table2-5:E_ ft. Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EK Hardpan ❑ Previous Application Made: (If yes,dake--------------------) No ❑ New Construction: Yes ❑ No ME FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material................................................. E$BSting No. of compartments------------- ---------Size-------------------------------Liquid depth--------------------------Capacity-----------•--•------- Disposal Field: Distance from nearest well.---N-one-Distance from foundation--------1Qs----Distance to nearest lot line......... EjUsting Number of lines.....1---------------------------Length of each line---30t------.-----------.Width of trench....... - --_------------------- & ,ADD) Type of filter mafe`riall5.-ePt.--Rk---_Depth of filter material---1.8"----------Total length_-_--___30---------------------------- t at N Seepage Pit: Distance to nearest well---NCI1Q--------Distance from foundation.......3.Q......Dlstance to nearest tot line................. [x Number of pits-------t_-j----------Lining material...-ROCk.------Size. Diameter.----_-�_;--------Depth-----------12 f-------------- `�]�� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------ ............ ❑ Size: Diameter `i---------------------------•--Depth---------------------------------------------------.Liquid Capacity- -----------------•---gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.-._-----.__----__------ ❑ Distance to nearest lot line-----------•----•--------------------------------------------------- Remodeling and/or repairing (describte)---------------- ----------------------------------------------• --- --.-......-----...-----•----•---------------•----------------------- SUPPLEMENTARYDRAINAGE-.-. _ __ ---------------------•- 1 --------------------------------------•---------------- ---•------------------------------------•--------------------------- ----------------------------------------..............-•-------••----------------....--------------------------------------------------------------.----------••------------....__.------:..----•--------------------------- 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 +he San Joaquin Local Health District. The DAY &__NTGHT_.i_ _Seiotic Tank service. (Signed) ..:.-..- -- •--•• -- ---------------- ---------------------------•(i5�M Contractor) f. - By:......... --------------------------i............-------------------------------------------------- ..... ........Ant le)----------------------------------------------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). , ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ----------------- ---------------------------------------- DATE---- --- ----- �� REVIEWEDBY------------------------------ ------- -------------------- ----------------------------------------------------------- DATE- ........ BUILDINGPERMIT ISSUED --------------------------------------------------------------------------------------- DATE.---•------•-------- Alferations and/or recommendations:---------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- .... ---------------------------------------- ...------------------------------------------•----------------•-------------- ---------------------------------•---•-------------------.-----------••-•--••---.--------•--- �. FINAL INSPECTION BY:..........-�•� -- - --------------------------- Date-----------------�:....�.--�- �-�--�-----------�--•-�•-----�-•---.... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 705 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 RM 5-61 ATLAS