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1 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicafe) I Date Issued .__ A plication 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---------4a4_-Xorth.3r-ea s--Stocktm (Weat__-bf__ aJugt-en__A0n0� ............ ---------- Owner's Name '6r34jms's-e-- r-tiest__Gogn&----•-----••-------------- -- ------. . Phone-_2.-4-065-- ---------------------------------- - Address------JCL7e.S4wth.wi 3,g=--*Y-r-_stoLckton - ---------------------------------------------- Contractor's Name-------�oit3s--S.--3'ex' `y--4HARM411IY- S}---Calif-L1c.4'/`_/;f71F�----- Phone_=43__le-------------- Installation will serve: Residence :k] Apartment House ❑ Commercial ❑ ,Trailer Court ❑ Motel ❑ Other ❑ Number of living units:& /Number of bedrooms ---2... Number of baths ._ _ Lot size __ ----_S�f Water Supply: Public system ❑ Community system ❑ Private:k] Depth to Water Table -------- ft. well SDsf jadp Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ei Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes (.] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well---62---------Distance from founda�on____1Q+__-___-.Mate i I__ n No, of compartments-------------------- -----Size-- •-- - - - Liquid depth p- ---- --__iJ-__.__Capacity_- -��__-----� ` . . . _Disposal Field: Distance from nearest wefi_-._____al .._.Distahce from 4eU,�a� __0--_---_---- istanc�-i-o nearest lot lin ._y _t___._-W [� Number or` lines__.___p ength of each line________iQ.�-____r ..Width of trench-._.____I�r_ -_ -------------- Type ______._____Type of filter mate ri ` 7 pfh of'filter material----- length--------- *4210---;-------- Seepage _ _Seepage Pit: Distance to nearest..well... _Distance-,frlom foundation_._... Distance to nearest lot line-___._ ._ Number of pits-----J._ ___._-____Lining material--- Size: Dia 4iieter------- _. __-__.. - :- Depth _ - LL — ;v 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 describe :_.=_l_in�e__-_________`_____------ Remodeling __ and/or repairing �- - -----:+____ ----4-------- ------a ---- -----------------, --- -------------------•---- - - - ----------- - ------ ------------- ------------------------------ -------------•--------------•-------- z � --------------------- ---- -------------••-----------••------------------------ ------------------------I----------------------------- ----------------------------------------------------------- I hereby ce ' y that I ha ared thin application and„that the work will be done in accordance with San Joaquin Count ordinances, Sfat S. and r lations of the San Joaquin Local Health District. (Signed) GeiiB � ---------- -- - ------ ------- -- ----- ---r-- '• = ------------ -----------------.(Owner and/or Contractor) Piof Ian, showing size of lot, loce�O - -- system m relation to wells--- buildings" -------------(Title)______-1 nora._CmtrAoto ___- y' ( P 9 dings, can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPI KrATION ACCEPTED BY- ---- - --------------- - ---------------------- ---- ---------------------------------•---- DATE---- REVIEWEDBY--- ----- ------ ----------------------------------------------- -------------- - - ----------------------•_.---------------------------------------- DATE-- ---- BUILDING PERMIT ISSUED = l ------------------------------------------------ DATE------ Alterations and/or recommendations:----------.,--- ==- -------=-- - ------------------------- = -= =�_: Q ..------------------------I------------- ---------ew------- L} ----------- tom_ `t} __ = _: �.�' ------------ - a ---`--r-- _ - - -----•- �- ---•------------- ----------------------- a T 13 FINAL INSPECTION BY: -�--- - --t - ------------- q „ Date.................. .' t��.. SAN JOAQUIN`LOC_AL-HEALTH DISTRICT '. ; 130 South American Street 300 West Oak Street f .'132 Sycamore Street ~ 814 North "C" Street Stockton, California Lodi, California ` Manteca, California Tracy, California t' ES-9-2M I0-52 Revised W-2100 ' 1