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r 5 APPLICATION FOR SANITATION PERMIT Permit No. 1,a/1N (Complete in Duplicate) / 54 Date Issued _____ L 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_ 1390b Broadway Hatchery JOB ADDRESS AND LOCATION--------- ------�toGy oxl-----------------------------------------•------------ Owner's Name...........ja_ckt---Bjll?---GC_o_.__-a at_0W-------•----------------- -------------------- -- ------------- Phone_HO-----4Q_9Q6-------- Addresi ---------------`S ama----.'--•------------------------------------------------------------------------------------------• -•--------------------- -----•------------------------------ -------- �:=---- xo 2 -046 Contractor's Name----------•-Day---&Night 'S -t-1C__Tank_ Servic_eA------------------------------------- Phone----- ---------7---------------- Installation will serve: Residence =Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ZX Number of bedrooms __x___ Number of baths x_____ Lot size -----1-501----x"__17-51______--------------- 1 Water. Supply: Public system ❑ Community system ❑ PrivateXX Depth to Water Table __ o_`ft. k Character of soil tat,0 depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[I[ Hardpan ❑ P io"s Applicationk-ade: Yes F1 No [K New Construction: Yes [X No E] FHA/VA: Yes E]0No �;�.. f I 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___-125-- t- Distance �rom foundation____�51_"_____.Mate'ial___ _ _-- CiCk-"--------------------- ts __ 5. _fi_--X36 ------ -----r-6 ----------- Capacity------ 8QQ___Gals .xx No. of compartmen -------2 --------- Size61t - ----- Liquid deptht Disposal Field: Distance from nearest well----1 00t._.Disfanc�from foundation__-15!—____--Distance to nearest lot line------5_"-_.." Number of lines-- ------- --------------Length of each line------�FQ______-__it_____.Width of trench--- __--- --------------____-- Type of filter material---+S__e ..__-Rk-Depth of filter material--------3.8 __-___Total length-------------4D____-_____--_----______ Seepage Pit: Distance to nearest well-_1041---_ Distance from foundation- 16'- to nearest lot line_ St _____Linin material____ E)Ck ---Size: Diameter_____ _ ________ � Number of pits --1----- 9 .�.�11 -- Depth----------2-5'-- -- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 171 Size: Diameter-------------------------------------Depth--------------------- -----------------------------Liquid Capacity----------------------------gals. Q building_:_:_-.___ _ Privy: Distance Brom nearest well------------------------------------- Distance from nearest ______________________ --- -- -- � ❑ Distance to nearest lot line------ ----------=----------------------------------------------------•-------------------------------------------------------------------- Remodeling and/or repairing (describe) Rr-Oadwa'y--Ha ch—eu:------------1-- --- --------------------------------------------------------------------------------------------------------------------------------------------Z---was-__ba_sin�------------------------------------------------ t 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 Joaq ' Local Health isfrict. R & NIGAT SEt IC TANK SERVICE ---------------------(Q@W,�ontractor). (Signed)-JAY-- --------------- K--- ----------------- - B ------------ -- -- - -- ------- -----(Title)----------------------------------------------- -------"----- -- (Plot plan, showing size of lot, location of system in relation to I s',,buildiings, et , can be placed on reverse .t FOR DEPARTMENT USE ONLY { , APPLICATION ACCEPTED BY_ DATE _3 ---------------------------- ------- -------------------- REVIEWED BY ----------------- DATE- 2 •-------------------- BUILDING PERMIT ISSUED--------------------------- ---------- DATE-----'�---- _1 --------------------------------------------- Alterationsand/or recommendations:----------------------------- ------------------------------------------------------------------- C,!�-----------------•------------------------------- - -----------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------•---------- ----------I------------------------------------------------------------------------------ ---------------------._..------------------------ ---------------------••---------------------------------•------------------------- --------------------------------- FINAL INSPECTION BY: ------------------------- bate-.- '_ --------------------------------------- SAN -------------------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street a 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 FY-CO.