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r � r APPLICATION FOR SANITATION PERMIT Permit No. ..... 7.z_�_ _-_ t I (Complete in Duplicate) y Date Issued Applica+ion 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. s T LOS� JOB ADDRESS AND LOCATION.:....-a%---Bo---Corrie-r.-_ th--_and Harrison StseStockton LO 15 ,. Ib �.. Owner's Name-------- ta---$QT�a�' -----------------------••--------------- �.�--------------- -- ' - ----------------------- Address.---------............... - San Francisco - -••--- -----------------------•------------------------•-------------------•- ---------•-------------------•------- - ••---------•------- ----------- Contractor's Name by eTAln_.14x3'��-CO--------------------- ' -- ----•-------. Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: ..._ Number of bedrooms - ^ ? Number of baths -_ ._ Lot size ._.. .: _- Water Supply: Public system [X Community system El Private El Depth to Water Table _- -..._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayLoam Clay li ❑ y ❑ Adobe® Hardpan ❑ Previous Application Made: Yes ® No ❑ New Construction: Yes EX No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Septic Tank: Distance from nearesr we'I_=iae,---Distance from foundation._... a.Q-....._.Material------CO�iC__TB�E-• ' -.,- No. of compartments_------,�---------------Size----1!)�XXU Liquid de +h__--- --- ----- q p.' '5-----------------Capacity----1bOQ Disposal Field: Distance from nearest well_Z14I1e----Distance from foundation_.--. 10.--..._.Distance to nearest lot' li ne._5-ofNumbet ines-----------�---------------------Length each Iine� Q_-�Q--�Qe�� idth of french..._-..24_----------- --.--.-. TYpe of filter material---S;.T RUC �epth of filter material------ ,-- --- length--.._lZ{.�__ -------------------------- Seepage Pit: Distance to nearest well.._none_--...._Distance from foundation...__ � ---------Distance to nearest lot line ..--_.-5_---- Number of pits ------------ Lining material-----brick__-Size. Diameter--- Cesspool: Distance from nearest well ------------Distance from foundation------------------- Linirig material_.__-.--_--__..____-...- ❑ Size: Diameter----1------------ ---------- -------Depth-------------------- ----- ----- --- ' � -----Liquid Capacity----- ----------------------gals. Privy: Distance from nearest well----------------------------- Distance from nearest building--------------------------------------- --------------- ------------------•- Distance to nearest lot line_-._:__,..-_-____- ----------•-•-------------•-- Remodeling and/or repairing (describe):--------------------------- F --- �--------___ ----••-----•------•------------• --------------------------------------------------- y �- ---------t � _ ` -1------------• •------------•--------- ------•--------------------•----------•--------••-------•---------------- �C --------------------------- -------- --------- -------------•- -- --- I.hereby certify that I have prepared this ap lication and that the work will be done in accordance with San Joa i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. qu n County (Signed)--------------------------- -- ---------------------------- By:.-.------ --- (Owner and/or Contractor)&Z?_--, -----(title)-------------------------------------- (Plot plan, showing size of lot, locatio of system in relation toZ� -- --we s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY s APPLICATION ACCEPTED BY------ __.. _._ - ----------------------------------•---------------------- DATE------------ REVIEWED BY f -- -------------------------------------- DATE---•------- or " "` �J BUILDING PERMIT ISSUED------_-------------- - -- ----------- --------------------------------- --- DATE Alterations and/or recommendations: ----------------------------•---------•---•------•---•-------•---- t ----------------------------------------- .. -- - - _ '•-' --- ---------------- - -- - .... ``~- ---------------------- ,�D- -------- -- - -------------- - - --- ------ :---------- . INSPECTION BY:.-_-_-_- - - --------•----------------------------- Date..... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 1300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Cafifomie Lodi, California Manteca, California + t Tracy, California A ES=9-2M 145446 ATWOOD 12-54 ,