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FOR OFFICE USE: D --_�=. _-------- - ..- -------- --(-f ''---3.-0-„- APPLICATION FOR -SANITATION PERMITerg t No ------ -- ---- --I--------------------------------------- (Complete in Duplicate) ----.--- This Permit Expires 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. JOB ADDRESS AND LOCATION-------1* .35---Chcrokee.-M,-------------------------------------------------------------------------------------------------------- Owner's Name------ �kg.-...!T_?__;jhelton -----------------------------------------------------------------------------------------------•----- Phone------------------------------------ Address__-_----___5835_ Cherokee_ Ra. Stockton? Calif. -- --------------------••---•------------------------------------ Contractor's Name---------------------H�'shi�*------------� �' �.a,r ----- Phone--46 --.09------------- 1 Installation will serve: Residence ❑ Apartment House [] Commercial ❑ Trailer Court I�g Motel'❑1Other ❑ Number of living units: _:-__ Number of bedrooms __4__ Number of baths ---�-- Lot size ?X -? ------------------------ j Water Supply: Public system El Community system E] Privates] Depth to Water Table .-Wit. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan ❑ Previous Application Made: (If yes,date----------- -----) No [j New Construction: Yes FK] No ❑ FHA/VA: Yes ❑ No EJ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Disfance from nearest wef!____50t-----Distance from -foundation__lO t____--_-Materiai.__co.nC rot`, t] No. of compartm = ents-----3----------- ------Size---2,2X,5XLiquid rhth..-•__E2t--,_...... 9-----------Li e - q p Capacity-210Q---9&1. Disposal Field: Distance from nearest well.___ Qt-_-._Distance from foundation.-W............Distance to nearest lot line---- t---_-.-. Ej Number of lines-_--_!5---------------------------Length of each line_. -------------Width of trench----_--t-------•-----------_---.-- Type of filter material-----_r0ak-------Depth of filter material.-___, t..t--.--._Total Seepage Pit: Distance to nearest'well---100----------Distance from foundation__1Qt----------Distance to nearest lot line--.-�*------- ® Number of its-----. . - x'57 - Vn, p --- .___--Lining material----- .__---Size: Diameter--. �,�'Depth-.-fir-5------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation___.----------------Lining material---------------------------- El -' Size: Diameter Depth = =-------------- --------------------Liquid Capacity gals. Privy: r°• Distance frgrn nearest welf------_-------------------------------------------Distance from nearest building----------- --t:------.......... Distance to nearest lot line- ----------------------------------------------------------------- ' i Remodeling nd/or repairing (describe):_-_------------------------------- _ ------------ ----------------------• fib ----------------------------------- --------------------------------------- ----------------------- = -------•---•--------------- ---- �\ ------------- ---------------------------------------------------------------------------------------------------------------------•------------------------------------------------- ----------- 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, l�0 (Signed) � /` - J- ----- ----------- -----j -------------------- -------------- - {Owner and/or ContracfarJ B � . �E/�. c `. em la (� Title , (Plot plan, showing size of lot; ocation of s in tion o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE: ONLY APPLICATION ACCEPTED BY------ ----- DAT ------------ 1 .-.- F REVIEWED BY-------------------------------- ------------ - ---------- --- -=------------------------------------•--- DATE BUILDING,.PERMIT ISSUED--------------------------------------- ----------•--------- :,--------------------------------- DATE - Aiterations and/or recommendations:- - --------------• - ----- ---------------- -------=--------------- ------------- --,��s--�,P-,��--- - ---------- ------ - -------- �. �_. X r ---- `~^ --------------------------------------------------------------- -•------------------------ -------------------- ------------------------------------------------------------------------- FINAL INSPECTION BY:_ �- --------------------------- Dade----------- '-- '------------------------L% SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stoeklan,California Lodi,California Manteca,California Tracy,California ^ y