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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) # 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______ ____ ---------1 + So. Sinclair_- St. Stockton'- -_ Owner's Name-----1--------------------- Cla;X'enoGE__A.___Bi&ts---- ---- Phone---- -- L. "Address - - -1`- = -. $a7 W:,*_'Tringent-on----------------------------------------------------'-------------------------------------------------------------- Contractor's Name------------------1).___A PA-13RE -•-----------------------'------------------- Phone-----9m997-------- Installatio willserve: ❑]` hu Residence Apartment House M Commercial ❑ El Trailer Court Motel Other Number ❑ living units: ED ter of bedrooms [ T646 of baths E2 Lot size___-_--7 ______ _ Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑Sandy Loam ❑'Clay Loam.[ .Clay.❑ .Adobe l] Hardpan.[] 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---------------i___:Material_'-------------------------------------------- .__. ❑ No. of compartments--------------------------Capacity-----------------------SEze---•------------------------ L quid.'depth---------- -------------- ,v Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining ______________________-__-_-_' De th_-�--' ❑ Size: Diameter---------- ----------------------------- p : ----------------------------------------- ' 1 s Privy: Distance from nearest well________i-------------------_________�=_________Distance from nearest building_ ___________________________:.________. ❑ Distance to nearest lot line--------_-------_________________________________.-_ I 'Seepage Pit: Distance to nearest welL__N—i--______Distance from foundation__l��____-__:_Distance to nearest lot line_- -- - i ' Number of pits______I------------Lining material_-CC_1!:L(�7&ze Diameter__=___)+2rt_-:___.Depth_____________30___£_,____ Disposal Field'. Distance from nearest well________________-Distance,from foundation_______________ __Distance"to nearest lot line_________________ ❑ Number of lines--- -------------------- ---------_-------I--__--Length of each line--------I-----------------}__.Width of trench------- ----------------_-----___ Type of filter material--------------------—Depth of filter material1----.----------- r=�"" Remodeling and/or repairing {describe---------____► ]ltZL'3ESl _ -S4_f' 7. rL --___.__--- .----------------------------------------- _--------- -------_________________________________- -Y_-____.___ ___''__-___---_-__-______-___________----__-_________-____-__-ate____ ----------- -= = ----------------- I t { _ -! -------------- ---- --------- ---- - ---- ` I hereby certify that I have prepared this-application and that f e work will'be done in`accordance with San Joaquin County ordinances, State laws, and rules and'f gulations of the San Joaquin Local Health District.- 1j i [SigneaB A_ ASHSONS INC-.----------------_•,-------------------- ------------ ---'---------(��Contractor) .� I (Title)---EStimatoI' =________ ___1_.___ _-__. _ __-_ _ ..____._______________________________________________ ______-_-_ _____ 5_[Plot in-9--size of lot, location of cyst m in relation to wells,buildings, etc.. must be 4iledfwith this application). FOR DEPARTMENT USE ONLY t r REV - , APPLICATION ACCEPTED BY-------------' _ bA�E=-- �----------------:---._-------------------- , EWED BY:5�-------------------------- = DATE - 131 BUILDING PERMIT ISSUED------------------) - ---------------------- DATE------------•------------- ------------------------------ Alterations and/or recommendations:----F-----------------------------------------------------------------------------------=---------------------------------------------------------------------- - ---------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------- -------•- ------------------------ -----•---------------------------------- --- ---------------------------------------------------------- ----------------- -------------- --------- -- - -------=---------------�-----�-------------------------------- ----------- --- -------------- ----- ---- ------------------------------------- ---- -------- PERMIT N,,-- . --- ______________ ISSUED------ _-- - _-- y---_____[ ate} FINAL INSPECTION BY:---- ----------------------------------------------------------- Date---------------------------- __ ___Date----------------------------Z• �- --- -------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California '� ES-9---2M 9-50 W=1634