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I C)/ )/,�-r V;11' 4 APPLICATION FOR SANITATION PERMIT Permit No. /_(0�._._ Cs (Complete in Duplicate) 'yo /S f Date Issued ._---__---.,1__,------ 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--------91��...-so. Sullivan St. Stockton -------------------------------------------------------- Owner's Name-------------------------Ci`&Mat1on___AUA)rAZ--------------------------------- - ------------------------------------ Phone--•-------•------------------- Address-..-..-.----------------------------OaMe----------------*----------------------------I---- - Address-••----•----------------------------OaMe------•---------=----------------------------•------------------------------------------- ------------------------•-•----------------...------•------....-------- 1.4 Contractor's Name--- DgY-- dight Septic---Tank- Service - Phone..H�. 2 Installation will serve: Residence MC Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .1.._. Number of bedrooms ___z_. Number of baths ..-.1. Lot size _----..- - - ..-x...125 -.-___-__.__.__.__----_ Water Supply: Public system MC Community system ❑ Private ❑ Depth to Water Table ...P�t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Gay Loam ❑ Clay ❑ Adobe)M Hardpan ❑ Previous Application Made: Yes [] NoX] New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No [t* 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------------------------------------------ ------ ExEsting No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity------------------ --- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- n ExUting Number of linas-----------------------------------Length of each line------------------------------Width of trench-----------------------------------— Type of filter material-------------------------Depth of filter material-----------------------Total length-----------_-.....__..__----- -------- Seepage Pit: Distance to nearest well....None-------Distance from foundation10 t_------------Distance to nearest lot lin. .�0. �------- Number of pits.--.l--------------Lining materialRQCk-----------Size: Diameter-----33--------..--Depth---------------------------------\A Cesspool: Distance from nearest well-------------- Distance from foundation.--___----.____-Lining material-_____--.-.._--.-.-._-_.-•-..-_----- r ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. n Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------.--------I----- /1 ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------- ---- + Remodeling and/or repairing (describe):....____**Supplementary Drainage. ------------------------------------------------------------------------------------------------------------------------------------- C 3 1 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 Joa ' Local Health District. Da & Ni t Septic Tank Service (Signed) t ------------------ - ------------------------ - ------- -•----- - ---------------------------------(01Contractor) Title). (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc. an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - - -- -- ------------------- -- ---------------------------------------- DATE------Y/_ ------------------------------- REVIEWEDBY------------------------------------------------------------------ ---------------------------------------------------------• DATE------------ ---- -------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------ ------------------------ Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- -------------------- --------------------------------- ----------------------------------------------------------------------•------------------------------------------ ---------------------------------------------------------- --- --------------------------•--------------------------------------------------•------------------ ---------- - ` ------ = --- ----- -- - - - -L - - ----------- --- --------------------------------------------------------- ---------------------------------------------------------------- FINAL INSPECTION BY:.f'vTXr�- U%- ------------ Datel._ --------------------�� -- --------------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 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.