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FOR OFFICE USE: - -- ----- ---------------------------- ------------________. ____ _______________._ APPLICATION FOR SANITATION PERMIT Permit No. .. 1� c?..Z.. -- (Complete in Duplicate) L' Date Issued ------------------------------------------------ ___. This Permit Expires 1 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 described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---__Rt!-2 Box_872 A, Stockton: Ashley Inane (N) 2nd east of Femwood ----------------- -------- ------------------------- ------ --------- Owner's Name-------------•-----------•------------Arthur--Smith------------------------------------ ---------------------------------------- Phon0g!!r 782----- --•----- Address---------------- Same ---------- ------------- -------- ------------------- Contractor's Name___. hP.. __`-` NIGHT Septic 'rank Service 46b�38�f.1 ---------------------------••-----------•--------------------------------- -------•-------------------------------- Phone--••-----•------.......---•-------- Installation will serve: Residence [AX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number'bf living units: -1- Number of bedrooms __3... Number of baths _1_.._ Lot size _--___75.t__Z 1'50-t___-_________---__-__-__--_ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 64__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ] Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No AX FHA/VA: Yes ❑ No ❑ 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___-_-.._---,___-._._____-_.__-._....____.__. Existing No. of compartments--------------------------Size-----------------.--------- ---Liquid depth_------------------------Capacity------------.-.--..---- Disposal Field: Distance from nearest well 80t....._Distance from foundation _._�"5_f-__--_.Distance to nearest lot line_____l© _-__- P�xi.sting Number of lines-_ 1 ___ . Length of each line-----30 -----------------Width of trench 424'a-_ . __-- & ADD Type of filter material dept-------------------Depth of filter material_ l9 g 30424' a --Total length - --•---•--- ---------------- Seepage Pit: Distance to nearest iell_ .10Q1. Distance from foundation -_- t. Distance to nearest lot x___25"_.._ Number of pits------- ___. ___Lining material-------------- Size: Diameter-____-33n--------Depth----- ---------------_._..--_-_ fp 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 --------------------------------------•----------------.-.-------------------------------------------------------- Remodeling and/or repairing (describe):___________ _______ E E T $ R I ---------- ---------------•-----.-_.---•---------------- --------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------- - I hereby certify that ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, awdltalles and regulations of -San Joaquin Local HieSith District. a� & 17 7//�� J// (Signed) SEP i iC `F`ANI� �ERViC1= - -� .J ----------------------------------------------'� ansVaL_Contractor) By: 2915 E.Miner Ave., - H®.6-8841 ------------ ------------------------------------------- --------- Title) - - -- .....--------_.---------- (Plot plan, showing size of lot, location of system i la to wells, buildin , etc., can be placed on reverse side). FOR DEPART US ONLY APPLICATION ACCEPTED BY--- - - ---------------------------------- -------------------------------------- DATE----- 1`��-------. REVIEWEDBY--------------------------------------------------------- ------------------------------------------------------------------ DATE----------------------------------------- BUILDING PERMIT ISSUED-------------_--------- - J ATE------------------------- --------------------------------- Alterations and/or recommendations:..__--.___ ._ ___-.-__._.___ '___..... �` ^__ _ _ _______ --------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------_---------------------- ----_...------ ------------------------------------------------- ---------------------------------------------------------------------------------- ----------------------------• -------------------------------------------._-------- ----------------------------------------•--------------- ------------------------------------- ------------------------- --------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:--- � . ate Date_---._�� - _.____________________.___.__. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.