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FOR OFFIC/, U7: �J .----_.__-_ ------ __.._ __ --___---/__-__-. APPLICATION FOR SANITATION PERMIT ermit No. .__/...3�?._i .. --- --------------------- (Complete in Duplicate) / r --- - ---- - ----- -- ------------- This Permit Expires 1 Year From Date Issued Date Issued -.711-e-A-1 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. 2-7!Y ?v JOB ADDRESS AND LOCATION________2 25---Spe'�B" Street__--}-__Stockton Owner's Name---------------------------------------------merle---Ct�I-ZZ'_t2;JS-SSi----------------------------------------------------------- Phone---HQ...�2,537--------- Address---------------------------------------------------------`3S--a MO------------------------ Contractor's Name--------SpaySpalf---------------------------------------------------------------------------------------------------------•------------•-- Phone-------•--------------------------- Installation will serve: Residence-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other OC Wash Rm Number of living units: -------- Number of bedrooms __--_--. Number of bath-_-_ Lot size ---17-j-1...A..... ��_D___ Water Supply: Public system KK Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[X Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No [I FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t/0u X Sx '17 (No septic tank or cesspool permitted if public s er is available within 20 et.) Septic Tank: Distance from nearest well---NO.21e-._Di pnc /F ffo tion---1Q_!--------Material-------Rewtoad...2t'xU No. of compartments---------2------------ '------wj-d*iquid depth------I+II-1-!-----------Capacity-----�.200-..rs81 Disposal Field: Distance from nearest well---H.Qjae-._DisAnXfrog"Rdation----1„ r-----Distance to nearest lot line.....l !_... ® Number of lines---]_-----------------------------Length of each line----:4:0_ -.3 .__.__._...Width of french-----_-__2Lk______---_ Type of filter mate ria l__S.Spt_--Rk.--Depth of filter material-------1$"---.---.Total length-___________ }rS Z.___________ Seepage Pit: Distance to nearest well-----N one------Distance from foundation___5.0-r.........Distance to nearest lot line.....1_5!_-__ A MC Number of pits-------.1------------Lining material—Rack. Diameter--------33"------Depth_-___--_--2.5_x___._______ (V� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__..-_-_.----_____-.--_____._____-.__ 1 ❑ 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):'+-F-Or---W&S-.__-tU-b---aY;id.__f_Llttre...tol a-t- -----------•-----------------•-------•-----•------- -----•------•--------------------------•- •------------ -------•----------------••---------------------------------•---•-----•------------------------ -----------------------------------------------••-----------------------•--------------------------------------------------------•------------------------------------------------------------------------------------------- A' ---------- - -- - - ---------------------------------------------------------------------------------------------•-----•-------•--------------------------------------------•------------ I hereby certify that I have prepared this ap tion and that t work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulation ffAe San Joa in cal Health District. (Signed)--------Gene---C or_t apa.s.si---------.'' - - --------------- - ---------- ------------------.(Owner i1Q4 +iC1��l;' 7C) By:-------------------------------------------------- - -- -- - - Title--------------------------------------------_____ _ --- -- --- - - - -- - ------------------------------------- ot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --- --- _-____-, DATE_____.____ �_�__-_.__ ul fg - REVIEWED BY. ---------- i �' ,rir'-------------- DATE -`------------------------------- UILDING PERMIT ISSUED---------------- ---------- I ---------------------------------- DATE - ---------------------------------- Aaerations and/or recommendations:.____'._.._._-._.-_ -- --------------------------------- ---------------- - -- _... ----- ----- ______________ - ___. _________-____-__-..__________--__--_--___--_._-___________ ___. .-_.._.._ .-_.._ __--_-. _.. 1._-__.. .__. --__ ; V -_------_.. FINAL INSPECTION BY:__--_..L-,-_--. g:-.__- -_:__ Date ------------------------------------- SA N�ACAL H1EALTH DISTRICT 130 South American Street 00 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California i Manteca,California Tracy,California ES-9 REVISED 8.59 F.P.DD.2M 6.60