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FOR OFFICjE US : ° <br /> ....... ..../-- APPLICATION"FOR SANITATION PERMIT Permit No. ....... ............ <br /> . ----------------- .......... <br /> 2 r <br /> ------- (Complete in Duplicate) Date Issued L�h.34--Z-_ <br /> -----—--------------------------------------- This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 647. <br /> JOB ADDRESS AND LOCATION__..__.��t�_Dalhia Drive Stockton. Far M% ....... <br /> _­­1-­---------------­------- ----------------------------------------------------(1-12— .73g. ..... <br /> Owner's Name__________ZMYJEEUDW-W--ALD-E.R.S-,.C.ONSTFUCTORS -------- Phone.-..-GR 73626 <br /> __..............------------------------------------------------------- ------------­................ <br /> Address-----------------•-•- .....Q.-- B ---------------------- -----------------------......... <br /> Contractor's Namelhe.-. ........ -HO�-63-841...... <br /> NIGHTiS .T. Svc. <br /> --- ­-------------------------------------------------------------............. ----­------------------------ Phone__-- <br /> Installation will serve: ResidenceU Apartment House E] Commercial E] Trailer Court (3 Motel (3 Other [3 <br /> Number of living units:1------ Number of bedrooms _3--- Number of baths ___I. Lot size ---75f---X_-V±-Q............. ............. <br /> Water Supply: Public system UX Community system 0 Private F] Depth to Water Table --60- ft. <br /> Character of sail to a depth of 3 feet: Sand [j Gravel El Sandy Loam El Clay Loam 0 Clay F] Adobe MC Hardpan [I <br /> Previous Application Made: (If yes,dote---__------------) No E] New Construction: Yes XX No [] FHA/VA: Yes [I No 0 <br /> J <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well----ftne..Distance from foundation,----101--------Material------- ............ <br /> xx No. of compartments----------2-------------Size----5.611---X3_612----x6x', cl <br /> d .pth......6at!.-_---------Capacity..... <br /> Disposal Field: Distance from nearest well_N�rie-----Distance from foundation.....3_9!........Distance to nearest lot line.-.5-1........ <br /> xxNumber of lines----------------------------------Length of each line...6 0%,5 1.45'..Width of french-- 24 <br /> Type of filter material--- Depth of filter material-----181-----------Total length---- <br /> . . .......................... <br /> Seepage Pit: Distance to nearest well--WQM---------Distance from foundation----j69-f--------Distance to nearest lot line------- <br /> DIX Number of pits-----2--------------Lining material----Rock-------Size: Diameter---331-1,--------- Depfh--------a5t----------------- <br /> Cesspool- Distance from nearest well---------------- Distance from foundation--------------------Lining material________._..________._________--_._-. C.� <br /> ❑ <br /> aterial------------------------------------- <br /> ElSize: Diameter-------------------------------;-------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--- ----------------------------------------- ---Disifence from nearest building______._._...-_..___..........-..._.__.._. <br /> ClDistance to nearest lot line---------r-------------------------------------------------------------I---------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------- ----------------------------------------------- <br /> ..............­--­------------------ .........I..............I--------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------- ------------------------------------------------------------------------------------------­---------...........------------------------------------------- <br /> -----------------------------------------------------------------I-----­---------------------------------------------------------------------------------------------------------------------I----------------------------- <br /> I hereby certify that I have prepared this application and that the work will 16,4 done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the Sa;nlJquip Local Hea District. <br /> � /r <br /> (Signed) The DAY dc NIGHT...S...... ((:XMYaKMr Contractor) <br /> ------ ----------------------------------------- ... --------- ..... ..... .. - - ----------------------------------- <br /> By:----------------------------------------------------------------------------------- - --- -- --- ---- ----- --------- (Title)-------------------------------- ---------- ---------------_-_ <br /> (Plot plan, showing size of lot, locatio; of system in relati o wells, buildings +c., can be placed on reverse side). <br /> OR ARTINT USE&LY <br /> APPLICATION ACCEPTED B --------- ----------------- ....:f--- --- ------- ------------- <br /> I-------------- DATE-•-----`-ate-------- --------------- <br /> REVIEWED <br /> ----------- <br /> REVIEWEDBY................................ -- ----------------------------------------•------_-_-----------_-------............. DATE----- ••---._...----------------------------------------_... <br /> BUILDING PERMIT ISSUED....... . --------------------------------------------- ------t---------- ---------------- DATE. <br /> -- <br /> - W-A,— <br /> .. <br /> Alterations and/or recommendations:-- Q., D <br /> 44-�_ _ .- -----------_------------ <br /> . . ... ---- <br /> 4 <br /> ............................................................ -------------------------------------------------- ------------------------------------------------------------------------------------------------------ <br /> ................ ............. -­-------------­----- --------------------:-------------------------------------- ---------- -------------------------------------------------------------- ---------------- <br /> ........... ------------I-------- ----------­­­­......... <br /> FINAL INSPECTION <br /> BY:_/Ut -------- i�r� Date----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 360 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stacklonr California LbCllr California Manteca,California Tracy,California <br /> 46 9 FtEvI5ED 8.a9 RM b-61 ATLAS <br />