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FOR OFFICE USE: ---------------------------------- -- APPLICATION FOR SANITATION PERMIT Permit No. _;--_----- i ----------------------------------------- ---- -------- (Complete 4n Duplicate) ` Date Issued ----------------- This Permit Expires 1 Year From Date Issued -_-.-; -77/-. 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..i coiripli Toriiiif ie with County Or once o. 549. JOB ADDRESS ANDM(51ON__--_ Street at Street SW-E corner (west of school) Lathrop Owner's Name--------PHTT,T,__PS-_CQih�tT'ticti011__COit----•--------- ------ Phone------------------------------------ Address --------464-6998------ ------------ P. Oe Box 302, Lathrop, Calif. Address--....- -- ----------------------•- •---------------------------------------•------•------•----------------------------------•---•---------.-.---------------------------------------------------- The DAY & NIGHT Septic Tank Service Contractor's Name------------ -------------------- -•--•------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _A.---- Number of bedrooms ----�_ Number of bathsLot size -.x----ItJ©------------------------- Water --Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table -10--.ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam (C Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------------------) _.No-Ifr'�'New Construction Yes �o ❑ _FHA/VA:,Yes �No EZX 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-- ..--Di4ance from foundation_/-P-./----.Material.-_-._- 1yA No. of compartments___---.--- ___Size- ` ._ ` r� 5y Jbl --- - ?�_Y--ASC Liquid depth- �-? �'r�......... ...- Capacity... Disposal Field: Distance from n a7st weft-.......Distance from foundation----�1_-✓"___.Distance to nearest lot line-----e `er y� Number of line ------ ---- ------ -E ----Length of each line.-/s'�_�'B.' �,i"�+iidth of ...�t_ _------------ Type of filter materia��t Depth of filter material____-9_�t.......Total length---------------- ------l�-Q------- Seepage ---.Seepage Pit: Distance to nearest well------- ----------------Distance from foundation--------------------Distance to nearest lot line----------------- �Z ❑ Number of pits----------------------Linin.g material-------------------------Size: Diameter---------'-------------Depth--------------------------------- Cesspool: Distance from nearest well---------------:-Distance from foundation--------------------Lining materia ------------------------------------- Size: -------..-.--.-----.-----.._-_- I I, ❑ ----- Size: Diameter----------------- --------------------Depth------.-------------`----' - -Li Liquid Capacity-...-.-.-- - ------------------gals.j a Privy: Distance from nearest well----------------------- -------------------------Distance from nearest building ❑ Distance to nearest lot ine------------------------------------ '-ti I (4 r . Remodeling and/or repairing (describe)------------------------- -------'--- ----- ------------------- -- ----------------- ---- ---------------------------------------------------------- ---- '- P' -------------------------- I ., ----------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------� ----------------- ---------------------------------------------------------------------=------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, rules and regulations of the San Joaquin Local Health Disfrict. --------- ----------------- Contractor)TANK S _ 1 _ ERVICE____ ___ _s [Titlel-— - �: --------- BY:29�6 E:Mft�er4ve: --------- - --- -- - - -- - --- --- - ( p g X41 y r buildings, a c., can be placed on reverse side). Plot fan, showing size of dot, location of system in relation to ells, FOR DEPARTMENT USE ONLY r - - '-I 5 APPLICATION ACCEPTED BY..-.Ti_R-.�--------------------------------------------� ---- ------ DATE------ REVIEWED BY--------------------------------------------- = DATE' ..` BUILDINGPERMIT ISSUED------------------- --------------------------------------------------------------------------------- DATE------------------------------ ------ ----------------------- Alterations and/or recommendations------------------- ------------------- -- -- - -------------------------------------------------••---------------------------------------------- ------------------------------ ------- ------------------------------------------------------------------------------------- ---------------------------------------------------- ---------- ------------------------------•--------- ------------------------------------ -----•----------------------------------- --------- ------- ------- ------------------------- ------------------------ ------ ------- --------------- --- -- - --- -------------------------------------------------------------------- ---------------------------- FINAL INSPECTION - 7 Date---=---------�`�� r� ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Avg. 300 West Oak street 124 Sycamore Street 205 West 9th Street Stockton,California 1.4,California Manteca,California Tracy,Colifornici