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FOROFFICE,IJSE: ---- � - -----------------1- Permit No. ... ........ .. APPLICATION FOR SANITATION PERMIT � (Complete in Duplicate) D / --------- -- -------------- ate Issued `=-----• 1jP --�- _.___--__. • 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. S49. JOB ADDRESS AND LOCATION----------$23---X_-- P te r--Ave... Stockton -_-_•--- ..-. _.__. xR $ � Owner's Name----------------------------------------------- Na2almPhone - + f --•...----____....-_-.--_ A• --- _••-•---------------------------- ddress------------- ------------•---- �1��..--------------•--------------------------------•------------.......•----------- Contractor's Name h,_e__D Y & NTGHT ----- ice .- .._ Phone.- -..._.__----.-----•-_--__--- ------------------------" I Installation will serve: Residence p$'KApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other-0 Number of living units: _.a..--_ Number of bedrooms __1__ Number of baths I.... Lot size ------ ---------------------------------- I Water Supply: Public system ❑ Community system ❑ Privatela Depth to Water Table .-35 ft. I Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: .(If yes,date--------.-----------) No ❑ New Construction: Yes ❑ -No NK FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.._______.._ __Distance from foundation___________________.Material------------------------------------------....... E 3 ting No. of compartments--------------------- ----Size -------Liquid depth--------------------------Capacity....................... 1Qt Disposal Field: Distance from nearest well-----5q-to ___._Distance from foundatin.. Qt--_____...Distance to nearest lo line.... g E�.sting Number of lines-------1-------------------- Len th of each line.-----4Q--- ---- ---------Width of trench........ ...................... -•- & .ADDS Type of filter material�Ept_ _.Rk�epth of filter material_._-.��_.___.__...Total length__.---_--4Q ------------_------------- Seepage Pit: Distance to nearest well-------7.,rit:____-__Distance from foundation___- _��...._..Distancea tto nee lot line___..$ -------- p� � Number of pits.........1----------Lining material__.__.....Qck--.Size: Diameter____ 48,---Depth r Cesspool: Distance from nearest well-----------------Distance from foundation--------------______Lining material..__.______--________.____---_____. ❑ Size: Diameter-------------------- ----Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy- Distance from nearest well------------------------------------------------- from nearest building____.._______-_______----------.-..---- ! ❑ Distance to nearest lot line------------------------------ --------------------------- - ------•------•-----••--- ---------------- Remodeling and/or repairing (describe)__________________S.upple_mentary--- x_ais9e t•-•••----••••• ------------------------------------------------------- ------•----•---------•------------ ---------•-----•-•---•-•-------•---•--•------------- ----- ------.-------------------------------------------•--------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work ill be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of th a Joa uin Local alth District. ce -------------------------------------------------- Contractor) -------• Title------------------------------------------------------------ (Plot plan. showing size of lot, location of system in re ton to uildi , etc., can be placed on reverse side). F DEPARTMENT US NLY APPLICATION ACCEPTED BY-- d---- � ------------------------ ------- ------------------------------- DATE_..4=16._-62 ----------- ----•-------- --- - - REVIEWEDBY-------------------------------------------------------------- -------------------•--•------------------ DATE------------------------------------------------------------ v� BUILDING PERMIT ISSUED------------------------------------------------------- DATE. s _.. , J� — -------._l.!!l - cr373's "---••--�-------a-4------------- •-- ------- i.HR Alterations and/or recommendetions:___4_.__._4--.�________________ �- _a.!n. -? fi «a ls .+ ---- • •----------------- FINAL INSPECTION BY:. C� - ---------• --- Date_._..`-..'--- -{r' 2-•----------------------------------•-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 0 REVISED B•89 9M 5-61 ATLAS