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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued `► Applicatioon_ 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 40 Jess@ AVe. Stockton.---------------- ---------- Owner's Name-------MrS.---ID-Ul$--- ubbard ------------------------ --- ---------- ------------------------------ Phone__ 0_28804--------- Address----------.....-----------------------------------------447--J-es ae...A.Ye_:.f---- t0ekt9nA-------------------------------------------------------------------------------- Contractor's Name-----Tha_,Dk- Y---&-. 1GHT_..S_ep_ti.0___`I'ank-_SerV-iC-e----------------------------------- Phone------H0.--2-?_.046__- Installation will serve: Residence]M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: l____ Number of bedrooms ___3_ Number of baths -__3.. Lot size ------- X__15.01.___pluSportio Water Supply: Public system ❑ Community system ❑ Private CM Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe=Hardpan Previous Application Made: Yes ❑ Noll New Construction: Yes ❑ No IBS FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: XD (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material_______-_______-___-_______-_----_-___--_______ E3QstingNo. of compartments-------------------------Size-------------------------------Liquid depth--------------------------Capacity-------------r---------- Disposal Field: Distance from nearest well___-Q1------Distance from foundation---.�..Qt____.___.Distance to nearest lot line-----V-----_-- E�stig et n Number of lines._____.__________________ ______Length of each line_____�Dt_.____._________.Width of trench____.___��_______.__________._ & ADD Type of filter material-----S-ep..__RkDepth of filter material----1$E!_________Total length______________5Q!------------------- t Seepage Pit: Distance to nearest well_l00t_-___ Distance from foundation---�+0!.........Distance to nearest lot line__-5_ ------_ Number of pits---.1-___________Lining material---RD_Ck.___-_-Size: Diameter_____ ____________Depth_______2_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------.__--_-______. ❑ Size: Diameter-------------------------------------Depth-------------;-------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------.__________________-__-._. , ❑ Distance to nearest lot line--------- ---------------------------------------------------------------------------------------------------------------------------------- * jm&i5#j**_-----Mrs.---Hubbard---is.__f_or_zed...against---her_...�tiLL-- -a-.-utilise ' -a----saleable-_p rtinn___af__.-1and-_-on---whi-ch---to---.plac_e---part---of---thi __drains ge z_sys tete.---Th Skn_-J_oaquin._C_ount_y_---Ha4lth--Dis_t..__ ,- S_anittion__ ep_ -._--namely• r..____Ge4� ..._. sh__az3d -Haad di k Run _on__fnr .ad-_�_+ ;� a pian-.- e.�---of,,�--a. a k e i --_ - -tic), r \9 Jr f�a `I�i� e r 1 a#loo and �iaf1 ill a one n�cco e'w1Fh an oa n oun y x o mance , Steve 1 S. anel r T s and r ula s t S Jo 'n c ( th + i ___ Contractor signed)..The --X C�H'I'------Gegtic ani .Service ( ) By:------------------------- ------ f_ sc/ (Title) — ----------------------------------------------- (Plot plan, showing size of lot, location of system in relation to buildings, a ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ - DATE--------------- ------------------- REVIEWED -- ----REVIEWED BY------------------------------- ---------------- - DATE 6 ----- ---- BUILDING PERMIT ISSUED---------------------------- t -..--------------------- ------ DATE-------------- ------------ ----------------- Alterations and/or recommendations:-------------------------------------------- ----------------------------------------------------------------------------------------------------------=--- ----- --- --------- --------------------------------------------- .............................................................................. � _ - -- -- cl' --- -- -- ------ J7 --�------- ----- ------ .-- FINAL INSPECTION BY------------- --'------------------------------------------ Date-------------. /!� ,.,.,_; 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 Revisea 1.57 F.P.CO.