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FOR OFFICE SE / -� �. - I/ ---- -----• ifs --.. � --------------------c�r---_------------ ----------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------- ------------------------ (Complete in Duplicate) IrRate issued C --------------------------- .. -.---.---.___--.-----.-.- This Permit Exi2ires 1 Year From Date IS R .-_--- -•-----•------:: Application is hereby made to the San Joaquin Local Health District for permit to construct and in '"ll`t work rel n P Y q p he rk he n described. This application is made in compliance with County Ordinance No. 549. Ir JOB ADDRESS AND LOCATION_...--X722» -.-Che-rokee.-_Lane . Stockton _ Owner's Name--•-----L-e.t� & E I''r��?1TlaI} ------------------------------------------- •------- -...... ...-__---- •• •--- Phone..-- � 2J�+62----•--- --hien••-•• - -- - - - Address---------- _.4.72B Contractor's Name---TJ1e._DAY_ &_NIGHT Septic 'Tank Service Phone.-- HO•--6 �g�l Installation will serve: Residence KI Apartment House ❑ Commercial ❑ Trailer Court El Motel [:1 Other [3Number of living units- .-2... Number of bedrooms ..2—SUM6er of baths ...1..eLo s zi e ------eL@Lc_h__1Q.1.-__Z-_.350 .....:.. _Water Supply:-.Public system ❑- -Community system-❑``PrivafeX] Depth-to Wafer'Table'60... ft. Y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a[ Hardpan ❑ a Previous Application Made: (if yes,date--------------------) No [; New Construction: Yes ❑ No ❑ 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 �1--7.Ot-------Di Distance from f founclation._ID!-.-------matei�al----.-CC Brick - t No. of compartments---- 6!!_x36_---_____--.---Liquid de th-----•58---------------Capacity ... Gals Disposal Field: Distance from nearest well---5Ot--.-----DiAnc6e fromafouAafion-____1Qt-.----Distance to nearest to life-.__5T:_.____. Number of lines--_-_---1--- Length of each line---- t 24- 2 g �O �T.._.-.._.Widfh of trench. ---.,..t....... -- Type of filter mate ria l...-S-e-pLt---R$Dep+h of filter material--_---�.$-----------Total length......... ....eaC-?---...--.- 5t Seepage Pit: Distance to nearest well__-QO�-------Distance from foundation-------.�Q......Distance to nearest lot fine................. 2 ❑ Number of pits. --- '-�1 ----Lining material-----ROCk----. Size: Diame11 ter...-3------------.Depth---------2_51---------------- Cesspool: Distance from nearest well-----------------Distance from foundation---_---.-.--_----.Lining material-----------------------------....... � ❑ Size: Diameter__.---------------------------------Depth----------------------------------------------------Liquid Capacity---------------_..........gals. rivy: Dis+ance'ftom nearesf;welL'----:"`-"- T----------- --.-------Distance from nearest building._-------------------------------------- ❑ Distance to nearest lot line----------------------------------------------- -•-------•........ .... ---------------•-•------------� Remodeling and/or repairing (describe)------------------ ------ --------------------------------- ----------------red. vidua�- system_. -or ea_ c . --------------------------------------•-----•-------------------------------------------------------------------------------------------------------••............:-.__....--------------- 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)-...... .he---DAY---&---NTGHT.-.--Septic- �ank__�erv�.ce�----------- --------------(4K,�Contractor) By:..................................... ------- -- - -- -- - --- --- - -------*-O"*-`------_--------{ritle).....----------------------------------......?:.. --------•---- (Piot plan, showing size of lot, location of system in relation to wells, buildings,efc., can be placed on reverse side). FOR DEPARTMENT.USE ONLY i APPLICATION ACCEPTED BY...---- ---- --- -----------------------•-------------•-------I- ----- DATE..--- ----------------- _REVLEWED_BY - _ DATE�- -- - rte` E- u ..,. r BUILDINGPERMIT ISSUED-----------•----------------------------•---------•------------------------------------------------- DATE-------------- •--------------- Alterations and/or recommendations:------------------ --------------------------------------------------------------•-.......................---------------------------.....--•-•------------- ^ --------- p - --1....................................I------•-------------------------------------------------------------------- -------------- I FINAL INSPECTION BY:.---_C- - 5---------------------------------- Date..... --------1----- �-Z.. . ------ � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 5- REVISED 6.89 YM 8.51 ATLAS