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APPLICATION FOR SANITATION PERMIT Permit No. - ... '---_-- (Complete in Duplicate) /- J� Date Issued---'f---c--t--y-.- Application 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.......1114__Arlington Read Stockton ------------------------------------------------------------------------------------------------- Owner's Name------------------------------------------�Af1t1.---•A-•--A09re---------------- ------------------------------------------------------ Phone---HQ•WZI2 --- -- - Address..................................-------•-----_---1.63-9--West---Lalle.----------------------------------------•---------------------------------•----------------------••- Contractor's Name-------DAY--84...$1NUT...`u"�'' 'I�%__T TANK SERVICE -------------------------------------------------------------------- Phone--R9-•-220f6--------- Installation will serve: Residence$X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --1.._- Number of bedrooms _2_ Number of baths -----__ Lot size ---5bt---X.....1.1-01 -- Water Supply: Public system;! Community system ❑ Private ❑ Depth to Water Table -_50> t. ti Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑- Clay Loam ❑ Clay ❑ Adobe WE Hardpan 0 Previous Application Made: Yes ❑ No [n New Construction: Yes ❑ No ❑ FHA/VA- Yes ❑ No ❑ S't ppl,®mentar TYPE OF INSTALLATION AND SPECIFICATIONS: Drain (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation....................Material----------_---__------------------------------ Easting No. of compartments--------------------------Size--------------------------------Liquid depth--------------- ----------Capacity Field: Distance from_nearest well-----------------Distance.from foundation--..................Distance.to nearest lot line................. ExU9ting Number of lines------------------------------------Length of each line------------------------------Width of trench _--__-•______.______._-......... Type of filter material------ ___--------Depth of filter material--------_-_-.--------Total length........._............................... Seepage Pit: Distance to nearest well --NOn-0------Distance from foundation___ 8t Z.Q --__-.Dist Ince to nearest lot line--... ' Number of pits- 3----------------Lining material R®ck--------Size: Diameter-----33_--_----.__Depth_----2-5__.................. Cesspool: Distance from nearest well------------------- Distance from foundation Lining material - --------------------------. 171 Size: Diameter--------------------------------------Depth--------- ------------------------------------ ----Liquid Capacity....... ....................gals., Privy: Distance from nearest well------------------------------------------------- from 'nearest building-_-----------_---_-.--------------------. ❑ Distance to nearest lot line ------------------------------ =• ------•- ----------•-------•-- ---------------------------- •--•-•---- Remodeling and/or repairing (describe) --------------•----- ------------- -------- -------•- ...........-.....................-................................. -------•-- ----•------•--------•-----............................................. +=--------------- -----------•----------------------••-----------------------------------------------------------•----•-----------------------------------------------------•--•-------------------- •---------• ------- I hereby certify that I have prepared this application and th the work will be d e in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Jo i 'Local Health Di rict. (Signed)........DAY...s&...NIS...SEPTIC_--T-AN - SERVI •--- --------(O�r�r Contractor) SERVI ----------- (Title)------------------------------------ -- ----- --- (Plot plan, showing size of lot, location of system in relation wells, building4ef be placed on reverse side). FOR DEP RTMFNT USE ONLY APPLICATION ACCEPTED BY--- ----- ----------------------------------=------- •--------•-------------- DATE.-,- ------ REVIEWEDBY ------------------- ---- ------------------------------------ -------------------------------------------- DATE-- ----------•---------------•----------------------- BUILDING PERMIT ISSUED............... -------------------------------------------------- ----------------------•-••-• DATE-------dA............................................... Alterations and/or recommendations------- ------------- ----- " `----------------------•----=•---•-----------------------------------------•----------------------------------------••---••-•---•- ---------------------------------------------------------.......•.................................................................................................................................------------------------•- -------------------------------------------------------------------------- ---------------------------------------------------------------------------------------•--••---------------------------------------------------- --------•-•-----------•-----...••-•----- -----•---------------------------------------------------------•-------.------------------------------------------ •----•--•-•---------------------- ----- ----------------------- ---••--•---•-•-------------------------- ------------ ------ -------------------------------------------------------------- ............ ---------------------------------C ---------•-----•-------- FINAL INSPECTION BY: Date. 4-10 ----------------------------------------------------- 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 ; Revised 1.57 F-P.CO.