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APPLICATION FOR SANITATION( ATION PERMIT Permit No. _ ' --------- (Complete _ (Complete in Duplicate) j Date Issued __----t� /S� Applica%n 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. mak,7 zc,P..1>p•i,C �� JOB ADDRESS AND LOCATION_____________________ 341:5 Stu(k ton ---•---------------------------- - ---- •---------- - -- ----------------••-------• ------------------------t-� Owner's Name-----------------EYE. `!'iYldell r - ------------------------------------------ .-_ Phone--------- -------------------------- 7----------------- ---------------------------------------- -•-------------------------------------------•---------------•-------•---------•------------------- ----•-------------------- Contractor's Nama._._.'_Da & Ni t S `!' SYC. HO 27046 - -------------------- - - - -----------------------------------------•---•---••----•--- Phone_. ------------------•------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ne ❑ Motel ❑ Other ❑ Number of living units: ____'i___ Number of bedrooms -------2Number of baths]-_____- Lot size -----6Q_1 d Water'Su I : Publics stem r __'----•----'---------- PPY y ❑ Community system ❑ ,Private EX Depth to Water Table ___3-ft. Character of'soil to a depth of 3feet: Sand E] Gravel [-] Sandy Loam E] Clay Loam E] Clay ❑ Adobe[I. Hardpan ❑ .Previous Application Made: Yes ❑I No EIK New Construction: 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--- 101 CC Brick Distance from foundation---------------�-Material---_.------ (� No. of compartments---_-----A--------------Size§A'-t$36"X60'� Liquid depth----�7�t._----------- Disposal -.__-_-1 109 _Ca aci F p Disposal Field; Distance from nearel5t well_-_sp _.__---Distance from foundattioon----- ------------Distance to nearest lot line 10 _-_____ZU 51 ____.__... Number of lines_,----1--------------------------Length of each line--_____50......................Width of trench-------•-PA- _____ Type of filter materiaL__ZEA'ti�_- Depth of filter material_.=_ "_--.__ �0 ft, ------------ Total length •• "�] ! - •-------------- Seepage Pit: Numbee'to near, well--.gaLini'n 10t t _bistance from foundation__'_____________ Distance to nearest lot line__._ ' g Bracg 6 201 to 2'bt p material ---- Size: Diameter-.-------- -tt----- ---Depth---------------------- Cesspool: Distance from nearest well----------_------Distance from foundation._._..__..._--.._..Lining material.____-__-_..-------------------------- Privy: _. ---------•------------ lr ❑ Sixes Diameter--- �-----•-- ------------------------Depth----- -------- ------ ---------------------------Liquid Capacity- ---------•--------------- 1gals. Privy: Distance from nearest well___.-_------_.---- --. --_--Distance from nearest building Distance to nearest lot line.__-...________________- ----------------------------- ------------------------- Remodeling ------------Remodeling and/or repairing (descr;be):___------------------ --------------------------------------- ----------------------•-----••----•----------- ---•---- ------- I s 1 --------------------------•-----------------------•---•--------------------•--•----•----•----••------------------••--------•------------------- -------------••---------•--------------- --------•------------•-----------------•---------•-------------------•-----•-----•-----------•--------------•----•-------------------•----•------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ' 4 ordinances, State laws, and rules and're ulations of the San Joaquin Local Health District. County DAY& NII HT r- ?t (Signed)----.._ Septic Tarik Service f T2"U.Ei"ili, io �a 2-7046 ----- � • -- ----------------------------•-- — _____ ------------------ can ____ By:-*-.' Y:--- __ ------------------StoGktor- -Qiif ------- Contract -- - - --------- (Title] ` (Plot plan, showing size of lot, locatioq'of system in relation wells, buildings, e - ------. ., can be placed on reverse side). ~ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED.BY __-- - -------------------- ----._ DATE.:--- REVIEWED BY — - --------.................. �'� ----- DATE BUILDING PERMIT ISSUED----------- - - = DATE. ------•---------••------------ Alterat`ons and/or recommendations: # r -^----------'----- x r �11 __ p . - -----•_.:- -� Via- -� r��d -----'`"'.�----=----;: -._- -. ___-____-�f`---- ��-�:t��_-:�';��,�4�- � --------- -----• __ w FINAL INSPECTION -•BY:-"-. •----------- Date -/ - -/ {.!� - --- -7---------- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+reef 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California - Manteca, California Tracy, California ES-9 145446 4TW000