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r APPLICATION FOR SANITATION PERMIT Permit No, (Complete in Duplicate} Date Issued - ____ ---- T __tj Application is hereby made to the San Joa Joaquin This application is made in compliance withCountyOrdenancealth DlNoC549r a permit to construct and install the work herein described. JOB ADDRESS AND LOCATION----------- ,° t rInderson St. Stocittcn ----------- -- ------------ ------ -------- ---- ------------------ ------- --------- Owner's Name--------- ------------ L k e >I�c��„I110r„o1�nc'- - ------- ------ --- ----- ....... Phone------ -----_ ------------ - - -----------------------------------------------I----------•---------------------------------- --------------------- Contractor's Name-------------------- •- .......... P!-,r, xsn IIjC a g 9607 ----------------------- ------------- ----------------------------------- Phone----------- Installation will serve: Resident - --� � -' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --_1. Number of bedroom s2-----__ Number of baths}_ Lot size - _ -__x 100 7 Water Supply: Publics stem ------------ ------- Y � Community system ❑ Private ❑ Depth to Water Table �5 ft. plus Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[f' Hardpan ❑ Previous Application Made: Yes ❑ No 9 New Construction: Yes ❑ No ❑ Dry tic^,off TYPE OF INSTALLATION AND SPEC]FICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesr well_----------------Distance from foundation----------- --_ ��Fting No. of compartments.._ Material. -. . --- Size------------------ - -------------------------------- Disposal -- - - --- - -- - -. --- - - - ---- iquid depth - �----- - -- Capacity Disposal Field: Distance from neare t well `40n -------- --- ------ (t _._-Distance from faundation..40-r __--_Distance to nearestiot ine------ Number of lines________ ___1r-tT _ _ _Length of each line_.2_0_t- Width of trent W Type or filter material.__ ._. " ---- --------` Depth of filter material ttlength--,-'-'� Seepage Pit: Total ------------------ Distance to nearest well-_-_.- _ P-._-_Distance from f�c�ation---- _.t-----------3 Distance to nearest iot line_._-_ IN t Number of pits-_. _. ._--._..---Linin material_ - ' L'" otr Lining .. CAize: Diameter- J De tn_ . - t - Cesspool: Distance from nearest well _________ p .._�- ---------_ istance from foundation_-.--_ ._-_-_-_-.Lining material--_--._-------------- Privy: -- ❑ Size: Diameter----- ------------ - - -Depth _... . • ----------- --- - - -- -- ...... --- Liquid Capacity- ---------------- ---- --gals. Privy: Distance from nearest well----------------- -- - - - ----------------Distance from nearest b0din ❑ Distance to nearest lot line. __--_-,-_-- __ _ g___ ________________ ------------- ----------------- ------- Remodeling and/or repairing (describe):_.......... ----------- ------ ---•------- --- ----------------------------------------------- ---- ..--__----- -- - ! hereby certify that ! 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. I._. (Signed) Pr,. i_I,SH Ia�C ---- --------------------- ^ ':-- -- -------------r�`---= By:------------- .4. £ i ( �Contract k -{ _:._ ------- --------- ( J Estimator (Plot plan, showing size of lot, location o em in relation to wells, irdings, etc., ten bel placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ----------I--- ---- --------- ---- - ---------------------------------------- DATEZ'. REVIEWED BUILDING PERMIT ISSUED-------------- - ---- --------------------------------------- - DATE-- - --- -------------- -------------_---------- -- --------------------------- Alterations and/or recommendations DATE ,, - - ---- ------ ----------- - FINAL INSPECTION BY;___.__-_-.__ -- ate.. - �- - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California814 North "C" Street ES-9-2M 10 52 Revised W-2100 Men+ace, California Tracy, California