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� r �\ 4 Permit No. ___(.. - (�-- APPLICATION FOk--SANITATION PERMIT (Complete in Duplicate) Date issued This Permit_Expires 1 Year From,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----------••---1029-North-_Ch�Zdree-8-�---Stockton-----Ca1i. -'------------------•---.----------•- Phone ---- -- ----- •---- Gra �, ZFB8 --- Owner's'Name Don--and Bobbi Harmon------------------------ 1 9 �-._Ch ldreas Leve. Stkt-n' --------------------------------------------------------------•--------•---------------- Address__._____ = Delta- Se tic Tank 6e ry ce, Inc.- --------------------------------------- Phone----HD' 3--- Contractors Name--------- p - Installation will serve: Residence [� Apartment House [I Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of livingunits: --- Brooms __�___ Number of baths ___?-_---- Number of be Lot size _--_��_______�- C�B �. ----- ---•----•--------------•------•- Water Supply: Public system ❑ Community system ❑ Private [* Depth to Water Table _ 5 ft. Character of sail to a depth of 3 feet: Sand '❑ Gravel ❑ Sandy Loam El Clay Loam ❑ Clay E] Adobe ® Hardpan ❑ , Previous Application Made: Yes ❑ No ® New Construction: Yes � No ❑ FHA/VA: Yes ❑ No A ± TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well____ ------------Distance from foundation_________________ Material------------------------------------------------- r Ex$gting No. of compartments--------------------------Size--------------- -------------- Liquid depth CaQatitY i Disposal Field: Distance from nearest well----_____________Distance from foundation--------------------Distance to nearest lot line--------------.-- ETA$ting . Number of lines--------------------- Length of each line-----------------------------.Width of french.-------------.--------------------- Totallength------------------•----------------------- Type of filter material__--______.,_---- __-.__De th offiltermaera---------------------- 1 1 Seepage Pit: Distance to nearest well__1Pa�_____---Distance from foundation____1�=-------©isfi--_Distance to nearest lot line_________.._ Number of pits------------ Lining material.---rOCk Size: Diameter---33--------------Dept h_10-------------------------- Cesspool: Distance from nearest well---c____________Distance from foundation-___---______,_---.Lining material_____________________________________� -Liquid Capacity ___gals, Depth------------------------------------------------ ❑ Size: Diameter-------------------------------------- q p tY f Distance from nearest building t Privy: Distance from nearest well ---------- --------- ----------------- -------------------------------------- ❑ Distance to nearest lot line--------------------------------------------------- � A W_ .er__B-ed--�O---exiatin _ s -stem- ----------- ---------------� Remodeling and/or repairing (describe):___--AAAiTig-_ _- ---------------------------------- --------------- ------ -------------------- ------ ---------- - ------- his I her ebStafie ala sh andhave rufes ondar gulat ns olf the San Joaquin Local kHeal Health trio}n accordance with San Joaquin County ordinances, __�Q��e�.C_-r�_� lc.i�-s---�T1��- ------------------- --------------------------------------- (Owner and/or Contractor) ($igned)------D1'�.t�- k-----�x-Y ------- ---- Tale Gena --Mir+--- ------- -- ----------- - By:-----P'lorry.-War'khan---------------------,---------------------- -- --- - ----- --- k (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE-ONLY J / } -�°f-rt� 'ti '- ---------------------------------------` ---- DATE----- APPLICATION ACCEPTED BYCrri_.- -�- --- _ PATE-------------------------------- REVIEWED. BY------------------ ----------------- ----------'-------------------------------------------------------- ----- --------- BUILDING PERMIT ISSUED---------------------- ------------------------._. DATE----- Alterations and/or mR+e a#ions:---- -------- / - -- -- dam' a ------------------------ --------------------------------------- Date----------� ----------- ---------------------- s1. f - � ��--fit-' FINAL INSPECTION BY:.I�r-,.--�-. SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi,,California Manteca, California y. ES-9-2M Revised 8-'59 F.PCo. ;