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FOR OFFICE-USE- ------------------------------------------ FFICEUSE:------------------------------------------ ------------- Y4 --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ____. _::__.____._ ------------ --- ------- ----------- ------------------ (Complete in Duplicate) "' %/6 S ---------------------- This Permit Ex fres 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. 1- }1Ror rrN rr S.1 Lathrop Village 2 N Street�etween 6th & 7th. on south side JOBADDRESS AND LOCATiON------------------------------------------------------------------------------------------------------------------------------------------------------------------- PHILLIPS CONSTRUCTION CO IM 464-6998 Owner's Name - - - ----------------------------------------------------- ----------- Phone- -------------- Address----------------------P'___fl' _Box 3020 Lathrop, Calif. X64-6998 ------------------------------------------------------------•--- Contractor's Name__._The .__DAY & NIGHT Septic Tank Service - ---------------------- --------------------------------------- Phone___________________________________ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. _1____ Number of bedrooms __3___ Number of baths _1__._ Lot size __1 _r -r�� Water Supply: Public system ❑ Community system 4 Private ❑ Depth to Water Table IL�,_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [2;X Clay Loam ❑ Clay ❑ Adobe ❑ Hard n ❑ Previous Application Made: (If yes,date______________..._-) No [""'New Construction: Yes ff No E] FHA/VA: Yes ; o ❑ 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---A-.---___Material_._._ --- -------- _____ _________________ 1" 01 No. of compartments..-_y_______________Size "M /X_6-2-iquid depth_j-C--*'r............Capacity__7�_Q��,o Disposal Field: Distance from nearest well ------Distance from foundation-------2-W.. 7Distance to nearest lot li V/------�1`m Number of lines----- ___________ _____ Length of each line_l.�'____-�_�__ _.Width of trench.______-____-___.___ Type of filter material. ___ Depth of filter material____1�!0------Total length._/ff�--------------------------._ � 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 materia)----.__-____--._-_--.__.____________ ❑ Size: Diameter----- -------------------------------Depth------------------------------------- ---------- - Liquid Capacity----------------------------gals. . Privy: Distance from nearest well___----------------------------------------------Disfance from nearest building_____..._______-_-____.______.____..____. E1Disfance to nearest lot line ----------------------- ------------ ----------------------- --------------------------------------------------------------------- r Remodeling and/or repairing (describe):-------- 7- i-. �-----------Bkr -------!-1--------------------------------------- Q_F ! T f�`19-- � ` -- -------- --------------------------------------------- ---- -------------------------- ------- ----------------------------------------------------------------------------------•--------------------•------------------------------------------•------- -------- ----------------------------------------------------------------------------------------------------------------------•----------------------------------------- -------------------------------- --------------- 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, nd mules and regulations of the San Joaquin Local Health District. (Signed) ---�---- - - ----------------------------- - - Contract or) L 'TfC TANK SEERVICE B)PO-E-MinerAve.....-ffE}•6.88427---------------------- / -------------(Title)---------------------------------------- - -- ---- -------- (Plot plan, showing size of lot, location of system in relati n to wells, build' s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. . ....T1 0--------- ------------------------------------------------------------ DATE-------5-7/3-- REVIEWEDBY-------------------------------- --- -- ----------------------------------------------------------- -------------------------- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED.---------------------------------------------------------------------------------------------------- DATE-----: --------------------- -------------------------------- Alterations and/or recornmendations:---------------------------------- -- ------ - --- ----------------------------------------------------------------------------------------------------------- ------------------ ---------------------------------•--------------------------------------- -----------------------------------------------------------------_---_----------------------------------------------------------- -- ------------------------------ ----------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ FINAL INSPECTIO Kl Date f =a7 ^ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California t' Lodi,California Manteca,California Tracy,California 5 l