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FOR OFFI USE- -----------------:----------------- ----------------- - --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --•--------------- --------------------I-.-.----.--.,- (Complete in Duplicate) Date Issued*'.-- ------------------------------------- --------------- This Permit Expires I 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 I descred. This application is made in=coml5liance with County Ordinance No. 549. , JOB ADDRESS AND LOCATION-------1506---K,,--Fi1bert--Str"- t-.-.---Stor_k-ton---------------------------I------------------------------------A:--------- ----------------------------------------- Phone-3-6&=4.65 ---------------- Owner's Name--------------- -7 Address---------------------------------.......... W W__-T-&ay_I---Lod-i------------------------------------------'-------------------------•--------------------------------:---------- Contractor's Name__the_-DAY---&---N-14G�T-T---8-eptjC----Tenk---Serviee-------------------------------------------------------- Phonie.466!r3$41--------------- Installation will serve: Residence-kk Apartment House El Commercial E] Trailer Court E] Motel 0 Other El Number of living units: ___-3L_ Number of bedrooms -2---- Number of baths --I--- Lot size ___65x--X-1251_______________________ -------- Water Supply: Public system &,Community system El Private E] Depth to Water.Table --6-0- ft. Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam El Clay Loam E] Clay (j Adobe& Hardp6n ❑ Previous Application Made. (if yes,date........-w--------) .No ❑ New Construction Yes E] No Mt FHA/VA.- Yes E] No El 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_________________Distance from foundation______._.______-__. Material .1 No. of'com- partmenfs---------------------------Size------------------------------Liquid dep�k--------------------- Easting ---Capacity----------------------- Disposal Field: Distance from nearest well.XQA15------Distance from foundation_____.Wr..._.Distance to nearest lot line-____E: ...... Number of lines_________3L______________________Length of each line-.-___20 _______________-Width of french-------M-2411 :--------- Type of,filter material-Sept---Ftk------Depth of filter material-----------------------Total length___.___________-__---________-_ __-_-._. Seepage Pit: Distance to nearest well._-Horia-------DistanCe from foundation-____5011______.Distance to nearest lot line.__0----------- sing Number of p;fs--------I------------Lining material------Rock-------Size: Diameter----3ji.1-------------Depth--- -- -----25 T---�_I---------- 0 Ce4oAdd Distance from nearest well-----------------Distance from fo'undafion_-----------------Lining material----- - ----------------------------❑ 6' Size: Diameter-------------------------------=-----De th------------------i-------- ----------- -------------Liquid Capacity--------------------------�_gals. Privy: Distance fromnearest well-----------------------_____________._-___.___'Distance from nearest building---------------------------------i-------- ' ❑ Distance to nearest lot line----------------------------------------------- Remodeling ine--------------------------------------------- Remodeling and/or repairing (describe):_-___.._____.__.___--: _+_- ___----- ---------------------------------- ------------------------- ----------------------------- --------------- -----------------------------------------------------------------------------------------SUpplementvxy---Drainage------------------------------------------------------ --------------I------------------------------------------------------------------- --------------------------------------------------------------------- ------ ----------- ------------------------------ -------- ------------------------------------- -------------------------------------------------------------------------I----------------------------------------------------------------------------------------------------- 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,ruies and regulations of the San Joaquin Local Health District. (Signed)-----------The--Day---&I'Might--3-e Pt ie---T-&�---Srervioe------------------------------------------------------------------- ontrdcf or) By:-------------------------------------------------------------------------------------- --------------------------------------------(Title)------------------------------------------- - - ....... (Plot plan, showing size of lot, location of system in relation to wells, buildings,.etc., can be placed on reverse side). FOR bEPARTMENT USE ONLY.. APPLICATION ACCEPTED BY ---- -- - ----------------------------- DATE__ �� 1' REVIEWED ATE-----REVIEWED BY--------------------------------- ---- -- -------:------------------------------------------------------------------------ DATE------------------------------------------ --A. ------ --------- BUILDING PERMIT ISSUED=------------------------- --- ....../21--------- -------. DATE Alterations and/or recomme'ndations:------ ---------------------------------------- ----------------------- ----------------------------------------------------------------- -- ------------------------1-1--------------- ----------------------------------------------------------------------------------------------------- --------------------- -- -------------------------------- ------------------------------------------*--------------------------------------------------------I---------------------..---•----••-•-------------- ----------------------- ------------------ ----------------------------------------------------------- ----- ------------------------------ --------------- ---------------------- -------------------------------------- -------- - ---- ------------ --------- --------- --------------------------------------- --------- ------------------------------------------------------------- --------------- FINAL INSPECTION BY Date---- -- ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave, 300 West Oak Street 124 Sycamore Street Jr 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'L3 F,P.00.