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FOR OFFICE USE: ------------------------------ --- -- ' ------------ - ------------------ --------- APPLICATION FOR SANITATION PERMIT ' Permit No. -- (Complete in Duplicate) Y - Date Issued _____1_.7-�Fr,� ----- -----------------------------__-__.-------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh 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---------------79-- ......StQ4,ktron.....Wdt._--------------------------------------------------- Owner's Name---Y_eet--- ]:...............--------------------------------------------------------------- -------------------------------------- --- Phone-_.HO•'----3-85.;L7.-- Address-----R37..Weat•_Anderson-St. S-t0Ckton:_._.Ca11_f.-------------------------------------------- -------------------------•----------------------- Contractor's Name--•----I?e tra:-$---•Raga-------------------- ------------•-•-------- ---- Phone99!t---3_--39.55-.---- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1----- Number of bedrooms .-- -- Number of baths -1----- Lot size 60_`.___x---120,------------------------------ Water Supply: Public system :F] Community system I] Private ❑ Depth to Water Table 3�_. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® • Hardpan ❑ Previous Application Made: (If yes,date--------------------_) -Non New Construction: Yes n No ❑ 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-----_--.__._-__--_---.-----_-_----_.--.-_._-_-. Exh3ting No. of compartments---------------------------Size------------------_- •---------Liquid depth---------- --------Capacity----------------I-•---- Disposal Fie#d: Distance from nearest well-----------------.Distance from foundation--------------------Distance to nearest lot line----------------- F1 Number of lines------'----------------------------Length of each line------------------------------Width of trench----------------.._----------------- Type of filter material-------------------------Depth of filter material----------------------- length_-_----------__--:_-----___-_-_----_-.--- Seepage Pit: Distance to nearest well-XkQn9---------Distance from foundation1Q'_._P V9iWance to nearest lot, Ma ----p1Us� ` ExU3ting Number of pits----------I---------Lining material.._rOCk--------Size: Diameter-_7�_.�-----------------Depth---_-.5-____----------.--------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--.------_--...._._------_---___---.-. ❑ Size: Diameter-------- -----------------------------Depth_-- -----------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-_____________________________--.___._____-- --Disfance from nearest building_____-_---.------__--_---_----___---._._. ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------•----------------------------------- Remodeling and/or repairing (describe):---Aadln& ock--f#- -..d t r_-Bed---to_ex-.stingy.-septic-------- aystem=-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------ ------------------------------------------------------------------- ----------•--------------------------------------------------------------------------•--------------••-•---------------- -• ---------- - -------------------------------------------:------------------------------------------ ---------------------••------------------------------------------------------------------------- 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) De-1-tw-is-ep-t_1-c---Iamb--- -erv_i0e Ina------------------------------------------------------------------(Owner and/or Contractor) By------------------------------------•------------------------------ -----------------------------------------=---------------•-------{Title)------------------------------------------------- - ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ----- � ¢-^-------- ------- DATE----------------z..--- = 1 REVIEWED BY ----- ----- -------------------- DATE BUILDINGPERMIT.ISSUED------------I--------------------- -------------------------------------------------------------- --- DATE---------------------------------------- --------...- Alterationsand/or recommendations-------------------------------------- -------- --------------------------------------------•--••-----------•-------------------------------------------------- ------------------------------------------------------------ - ----------------------------- ------------------------------------------------•-•----------------------•--------------------------------------- ---------------------------------------------- - ---- -------===-- ---- ---•------------------•----------- -•----------------------------------- ----------- �i ---- `---------------------- - --�--- Date---------------�-------� � � � ---•--• FINAL INSPECTION BY:_-_.... _.."... ._.�_ __- -- 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 E8.9 Rrv16EP 8.59 F•P.CC,2M 6-6P -