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APPLICATION FOR SANITATION PERMIT Permit No. ._� _f_...-. i (Complete in Duplicate) Date Issued -------------- �1 Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION________------__ 00 W. 6th.__.St.. Stockton . ----------------------------------• ----------------._..-. Owner's Name------------LA-LO---LQZ$�N ----------------------------------------------------------- - ----------------------------------- ------- Phone----HO--42-773-------- Address------------------------71Q_..W.--I�ew-a-rd---St-.----•-----_-----------:------------------------- Contractor's Name------D.AX- 8�.._NIGHT----�6--e t o---Tank-_S.e_ vi e--------------------------------------------- Phone..___H0_.2.74 -6------- Installation will serve: Residence xX Apartment House ❑ Commercial ❑ Trailer Courf ❑ Motel ❑ Other Ej Number of living units: .-1--. Number of bedrooms _--_.2 Number of baths ---1__ Lot size ------5Q1----x---1251---------------------__-_ 1 Water Supply: Public system CaCommunity system ❑ Private ❑ Depth to Water Table _35 ft. € Character of soil to a depth of 3'feet:' -Sand ❑ "Gravel D' "Sandy Loam ❑ Clay Loam ❑ Clay ❑' Adobe WC Hardpan ❑ Previous Application Made: Yes ❑ No.MX New.Construction: Yes ❑ NoZX 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-------------------------------------------------- No. of com artments-.______________________Size_.__..__----____-__ __Li� uid de th.-_______--._-._ -__-_Capacity Uisting P q 1? P Y Disposal Field: Distance from nearest well_------------------Distance from foundation--------------------Distance to nearest lot line_--__.__.__-_____ Uisting Number of lines-----------------------------------Length of each line-----------------------------.Width of trench----------------------------------- Type of filter materia!-------------------------Depth of filter material__-----___--.._'--___Total length . . - len'gth-___-____-____-__-__-_----_______ __--_t-_ -_--_- SeeP ge Pit: Distance to nearest well � 12_._____.Distance from foundation.3.Q.t....#......Dis'ance to nearest lot line_-__-._._ Number of pits------1----_-------Lining material----RPIk-----.Size: Diameter---33------------- Dept h-------2.5_r____._.-__._.... 1 Cesspool: Distance from nearest well------------------Distance from foundation------------_------.Lining material-_____-_----__.____-.----_-_____-___. ❑ Size: Diameter.... ...... -----.-Depth---------------------------- ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------V_'Distance from nearesf building___-_--___.__._______--._________.____._. ❑ bistance._to nearest lot line-'. _ =-=-------------------------------•-------------•------------------------------------------------------- Remodeling and/or repairing (describe):_-_-_S PPLUE_RT-aI'3T---i�T_aJmg_e---------------------------------------------------------------.-------------------- • •--•---------------------------•-------------------------------------------------=-----•---------------------------- ------------------------------------------•-----------------2------------------=------------------- -------------------------------- -----------------------------------=------------•-------------------------------•-------------------------------------•-----------------------------/------•-------------------------------- ---------- -----------------------------------------------•------------------------------------------------ ---.------------- •--•-------------------=---- --------------•------•---------------- - I-hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count t ordinances, State laws, and rules and regulations of fhe•San Joaquin Local Health District. i (Signed)--DAY &-NIGH'---e-pt .e_-_Tank-_SerY1ae. s - --------- - ---- ------------------------------------( fi r Contractor) By:-------------------------------- -----------•---....--------------------------------------- - ----------(Title)-------------------=------------------------------------------ (Plot plan, showing size of lot, location of system in relation wells, buildings, c., can be placed on reverse side}. y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY < -------------------- --------------------------------------------------------- DATE------- -:� 4__ 7)_ REVIEWEDBY----------------------------------------------------------------------------------------------------------- ----------------- DATE----------------------------------------------- BUILDING PERMIT ISSUED--------------------- --------------------- DATE-------------------------------------- .. l Alterations and/or recommendations:__.._ _ _ ____ _________ ----------------------------------------------------------------- J ---•------------------------------------------------•-------------------------------------------------------------------------------------------------------------------- ---------•-------------------•-•------------. ---- 1 ----------------------- ------------------------------------------------------ ------------------------------------------------------------------------•-••-- ---------------------•------------------------------------------- -----•--------------- ------•-------------- ----•---------------------------------------------------------------------------------------- ------------------------------------------ ------------------•-------------- ----------------------- .--- -------- FINAL INSPECTION ---------------------•• Date-- r'------------------------------------------ SAN --- ---------------------------••---SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1.57 F.P.CO.