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FOR OFFICE�II E: ----------- -------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------- [Complete in Duplicate) V2,Date Issued __ ..._ _ ___________________________.._...------------_.___._._._ This Permit Expires 1 Year From Date Issued f 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. JOS ADDRESS AND LOCATION.....73 N� P�rsaang --------------------------- ------------------ -----------------------------------• ---••-- d _._ -- ----------- roldJ. Brown Owner's Name---------------•--•-•----•----•--.... --- -- --- •--- ------ Phone..... Address Same .e -- --------_.. Contractor's Nam hf'___ ._& NIGHT Sep C Taunk Service -------------- Phone._ 0' 63_S�i.T.. Installation will serve: Residence [;:'Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___2,_ Number of bedrooms .-_2':_ Number of baths ___2_ Lot size ______150t:__X__200_'._.. 24r �Water Supply: Public system ❑ Community sYstem ❑ Private _Depth ro Water Table ______-. . I Character of soil to a depth of 3 feet: Sand ❑.Gravelfo Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�Hardpen ❑ Previous Application Made: (1f yes,date--------------------) No r7: 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 fee+.) l Septic Tank: j Distance from nearest well-_______________Distance from foundation--------------------Material_______________________________________________. EX.sting: No. of com artments--------------------------Size--•-------------------- Liquid depth_`....--- Capacity Disposal Field: Distance from nearest well-----------------Distance from foun tion ^"-.�-0=_-_.Distance to nearest of line.._lT- p 7og.. ' t. > - Number of lines_-_i---3 -- Length of each line--------------------- -____-Width of trench__-_2 ________ _______________ � 1��! e � Donde#io 1__.10�.___..Di4tance to nearest lot line____I- � + Type of filter'material__________________ pth of filter mater+aL_____�_._._________. Total length_______________________ Seepa a Pit: l Distance;to nearest well._______________._-.Distance from f k : Diameter___:___._-rt'_._-_____,Depth_____1:�____.____-5T - r Number of pits----- Lining material-----ROCk-- __.Size " 5 r -A i Cesspool: Distance from nearest well_________________Distance from foundation.---------.---------.Lining material_-____._______-__---___________------ i ❑ Size: Diameter------I------------------------- -----Depth.--.-'r------ ---------------------------- --------Liquid Capacity--------------•---------_-gals. I I R Privy: l Distance from nearest well______ ______________________________________Distance from nearest building------------------------------------------ oo x .__ ., ..... 1 ❑ Distance�to nearest,lot line----------------------------------------------------------------------- •---------------------- •---------------••------- Remodeling and/or repairing,(describe):------------- --. •-------------------------------------------------- ..-.-... ---•---------------.----------------------------------- ------------"•---------------•--•------------------------------� ---------------=-------•--------------•-----------• ---------- I dI t - ----•�-------•----------- t ------------------ I ++ ----------------------------------------------- I# E ----------------------- ---•------------------------------------------ ------ I hereby certify that I have prepared,thisrapplicatio • -•--- -------•---------------•-----------•-----------•--------•---n and that the work will be done in accordance with San Joaquin County ordinances,`State laws, and rules and regulations the'.San Joaquin Local Health District. + Thi DAX." &. NIGHTept� c'-T nkS�Fv c , 5i ned - - -------------------•-••---------------:--------------- ----- ------ ------ ------------------ ----------------------------- --------Contractor] (Signed) BY• ............------•---•........:...... ...... (Title) (Plot plan, showing size off lot,I cation of syst in re a+ion to wells, b kid+�etc., can be placed on reverse side). {� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--- ----------------------------------------------------------------- DATE---�P -Z ------------------------- REVIEWEDBY-----------------------•-------------------- _-----------Li -----------.__DATE-----------------------•----------------•--••-------------- -BUILDING-PERMIT'ISSUED----------------------------- ------------------------- -------------------- -•----------------- DATE-------------------------- ------- •- Atterations and/or recommendations:---ist`__ -_b. -------0,L:s ....... ----- - I Gam- - ...--vim {-------- ------------------------------ --------..._ ------..... ---------------------------- n . ------------------------------------------------------------------------ ...................................... --- ---------------------- -------------- -------------------------------------------•••--•------.... J FINAL INSPECTION BY: l�'S- ------ Date--- '',.------ ------ --------- -------- •"-•--------- 1 k SAN JOAQUIN LOCAL HEALTH DISTRICT; 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ' ES 9 REVISED 8.59 2M 5-62 ATLAS