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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ........................ -------------------- ---------- --- ------- (Complete in Duplicate) C S— 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. 'I JOB ADDRESS AND LOCATION-------353-5-----Maud e1d_-Aver' .. bd . _o1 ...............•••-••••-••-••---------•-•.._........••.......-------- I ----=�aai.e.4.. A-aams-.----- - Owner's Neme-----------------------------!---- -----------•--••-- Phone-----H0---53384------- Address............-------------------- ---....---Same...............-._.---------------------------------------------------------------------------------------------------.......................... Contractor's ---T-ank._Sexvice---------------------------------------- Phone....EQ-._63.$1+1--•--- Installation will serve: Residence]$ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: :_-___ Number of bedrooms _____I Number of baths ---1_ Lot size ...5Q'.__x_$......320t.................... Water Supply: Public system I$ Community system ❑ Private ❑ Depth to Water Table4O--_ ft. Character of soil to a depth oft feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IE Hardpan ❑ Previous Application Made: Ilfiyes,dote--------------------f No ❑ New Construction: Yes ❑ No 2314 FHA/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SAptic Tank: Distance from nearest well 1ff.(lt1e___._I)istanceSfrom foundation....1Q�_-------Mate;Ia1.___.CG---Br.�.Ck................... xxg No. of compartments-------P----------------Size----5- -..�3�2__---------Liquid depth-----58_____..______..Capacity.......8QQ...Q313 Disposal Field: Distance from nearest well-NDM----_Distance om foundation____2.01.......Distance to nearest lot line.. ? 4 am Number oflines----------1....-.__-__________Length of each line_____-}Qf___-.._`______.Width of trench.___._____--2_4!_-------------- Type of filter materiaL.._._►S.E _ 10__Depth of filter material-------�..9'._-------Total- length____-__-__4n.......................... Seepage Pit: Distance to nearest well__.-.1V.OI3E3...... Distance from foundation__.A01.------Distance to nearest lot line----5t _. Number of'.pits-----I--------------Lining material----R_ID&--------Size: Diameter----.-33.s_ _ Depth-----------2- t �N Cesspool: Distance from nearest well_________________Distance from foundation---------------------Lining material..................................... � .1 ❑ Size: Diameter--------•-----------------------------Depth--:------------------ -----------------------------Liquid Capacity--_----------------------.gals. T. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building---------------I.......................... uildin9---=-----------••--•-•---••-•---------.._. ❑ Distance to nearest lot line-------------•----- ---•--------------------------••-•--------------------•--------••--------•---•---------------------•-----.........-------- Remodeling and/or repairing (describe):-------------UACI-NG--,a�__'_HQ�SE,�-.,-.,•-----------•-•-------•-• -----....--•--........._---------_---------------- ------ i ----------- ---------•---•-••----------.......------.._..._.--------------•------•-•----•••--•------------------------•--•---------------•------------------------•----------------------------------- -- hereby certify that I have prepared this application and +hat the work will a done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Healt District. (Signed} The DAY & NIGHT 1D TDrik..S�x' . e --- (�fiKContractor) BY: " ---------------------------------------------------•- -------------------- -- -----(riifle)---•-•------------------------------------- ---------------_---- N I (Plot plan, showing size of lot, location of system in relation to I s, buildings, , can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- A / C - ... DATE r' REVIEWED BY-------------------------------- ------------------------------------- ---------------------------------------- DATE---------_- ------ --------•--------------•-•....... .. BUILDING PERMIT � 4 ISSUED--�--------------------------- : ------- DATE.---------------•--•----------------------------------•-----• Alteretions aLd/or recom tons:- --------- ••--------- ----------------- --------•---•-•-------.-----•------------•---•------------------------- :_d----------, ------ --- ------�---- --------- It -----------------------------------------------------------------------------------------•-------------------=-----------------------------.-..------------------------------._-..---------------.--------------------- --------------------------•--------- --------- --------------------------...._._._....--------•--------...--------------------------------------.........--------------------------------------.......................... FINAL INSPECTION BY---------- ------ --------- J°- Date .... :• -----------............. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED e•59 7M 5-61 ATLAS r: