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FOR OFFICE USE: -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _�'��,. --------------------------------------- ------- (Complete in Duplicate) ` - This Permit Expires 1 Year From Date Issued Date Issued _....._r._. 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___Schenkels___.Island. __Township-_ 1 Range 6--_Aa t-�Piver 'Drive_)___ Owner's Name________Samue�•___E. Bistline_ _ Phone-4-6-6-.2a0 ----------- Address _-_-._.- I -------- ------- ----------- ----- -------- ----- -- Address-----------4-415---N Pershing--- ve-'-f-- Stock �on� califarnia Contractor's Name---Modern Engr,& Construction Co. Inc_ _ ____________________.___._.____ 4 ---------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1___ Number of bedrooms ____1. Number of baths __2--_ Lot size ------------------------ Water --------- ------- Water Supply: Public(system ® Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam KI Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No ® New Construction: Yes ® No ❑ FHA/VA: 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__(__D21_.Distance from foundation_1_`J_.---ft._.Material......Fked'Fked�k-o.od----------------------- { ® No. of compartments-------2.----------------SizeSt�--KQ_--_Gal Liquid depth__S-tCI.._8.0Q---Wapacity---8Q-0---Gal . I Disposal Field: Distance from nearest well ._1 i-,.__Distance from foundation-3-5--_f t.—Distance to nearest lot line---9Q__ft- ® Number of lines-------2-------------------------Length of each lire------8-Q---f---------Width of french....Zt--------------------_------ Type of filter material-_Rock-----------Depth of filter material.....12_............Total length__.160---ft.__________--__ Seepage Pit: Distance to nearest well____------------------Distance from foundation-------------------Distance to nearest lot line__.______-..__-__ ❑ Number of pits---------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest weEi-----------------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-------- ------------------------------------------------------------- --------------------------------- ------------------------------------ r Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------- --------•------ ---------------------------- --------------------------•-------------- ------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County. ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, (Signed) 19 /.4 �,F1.f• l'= d .5 -- �� 4- (Owner and/or�tractor) !�G r t �a��C'lc-�'� �-------------------- ------ -- - - - ----------(Titley .........--- (Plot plan, sho g size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse si e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ----------- - . . --- DATE------- REVIEWED BY---- ------ ------------ ---------------- �--��------------- -------- DATE-- ------ -- -- ----- - BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------------- Alterations a d/ re ommen ion �.. . -_-o____ -------- L c a- --6 - ----- -- ��_ �.-' > --------------- -- - - - ------ �... . _ - --- - FINAL INSPECTION BY----------------------------------------------------------------- Date ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 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.