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K APPLICATION FOR SANITATION PERMIT Permit No. ""..."_"..."".... . (Complete in Duplicate) - nate Issued ."""3 Applica+ion 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-1750.. Q•---Dra..ke.--- -------St.o.c_ktan------------- � Owner's Name------------ ----Cha.S-. -- - C. L I`- --- -- �--- ------ ------- ---- -"-- a. ----•--•-•- --- ----•---•---••-•-------...--••----'-'------'- -------- ' - -- Phone------- Address-------•---------------- S,-�,me Contractor's Name----------------1)A_7_--&--- `�' ��. � �`: --------------- --------------- -- -----------'-- -----------'-. Phone-----�Q_."2"-7a�6---- Installation will serve: Residence Apartment House p Commercial E] Trailer Court E] Motel ❑ Other ❑ Number of living units: _I--- Number of bedrooms Number of baths 1----- Lot size --------- Water -----. 7Water Supply: 'Public system [X Community system ❑ Private ❑ Depth to Water Table _ �" ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay-Loam ❑ Clay p Adobe U.-' Hardpan ❑ 1 Previous Application Made: Yes ❑ No QC New Construction: Yes ❑ No Replacing caved in cesspool. { 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_Ttion-e-----Distance from foundation__-- 5---------,Material-----B:'1C "-, xx No. of compartments-------2-----------------Size----56ttx3_611x_61+Viquid depth_.S-9!�'-'-- . ..... itv...9Q0--------------- -----5 --- Disposal Field: Distance from nearest well"�Q"�] Distance from foundation----2.51---.....Distance to nearest lot line.----- 5l-"."__ ` ® Number of lines-------1----------- --- ---------Length of each line------5Q-f-----------------Width of trench. ' 24"_-' ' Type of filter material" S0--P.t_.-.Rk.Dep+h of filter material_.]. fit-_------.-Total length--.-5C t---------------------------- Seepage ______________ _________Seepage Pit: Distance to nearest weIL.NQ]2e--------Distance from foundation_-_ -3_Q"�_._.-...Distance to nearest lot line---- \ Number of pits- _ :--._. -..------Lining material----)3z'_1Ck----Size: Diameter---.-_- " " Depth--------2.5t-"------- esspoo: Distance from nearest well-----------------Distance from foundation__------------------Lining material-------- -""_--.""""_"-"-•""_"-" ❑ Size: Diamefer-------- ------- ------- ---------Depth------ ----------------------------- Liquid Capacity------------------------_--ga Privy- Distance from nearest well-----------------------------------------------._Distance from nearest building ❑ Distance to nearest lot line"-____"-""_-___---""____-__-,----'-'------------------------ Remodeling and/or repairing (describe):------------------------------------ --------------------------- --------------------------------------•-•----------•-------•--------------•---------------•---------------------- ---•------------------•----------------------------•------------ 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. . , DAY&NIGHT (Signed)------- --------------- e fiic-Tarek Service_ 1206 80.Eldorado--- O 2 '846 ----------- --------(�'ne tiara o ontractor) By' - •---------•-•--------Stacktonr-Q0•--- ----------------------------------------•-------•----------------(Title)......-_Pa.�t;l er----- (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ) r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..- .. ---_._._- - •---------- DATE f.r ---------------------------------------------------- -----------REVIEWED BY ----- --•' --'-- - ------ DATE-- ---• • ----------•---- ----------------------------- U1LDlNG PERMIT ISSUED ------------------------------------------------------------------- --------- DATE------ Alterations and/or recommendations:---------------.-'-'- - _ - -- -------•------ ---------- ----------------------------------------------------- .""_""__""""."_"."_._.-"" .-------ate------ ---- 1 R "------------------------------------------__----------_------' - FINAL INSPECTION BY:..- ' 5------------------------------ ate--..�-�----7� <.-�^ ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M t45446 ATW000 12-54 F