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FOR OFFICE JSE: , I - ------------ ----------��*_ PP(CATION FOR SANITATION PERMIT Permit No. .23 ------------------------------------------ ---- ----- ---------------------------- -- --------------------- (Complete in Duplicate) Date Issued ---- ........ ........ ------------------------------------------------------------ This Permit Expires I Year From Date Issued r Application is hereby made to the San Joaquin Local Health District for a permit toj.�"Tftructtancl install the work herein described. This application is made in compliance with County Ordinance No 549 JOB ADDRESS AND LOCATION_---------1726 Gilchrist......Ave.,._,,....S_t_o_c_kt on '--------------------------_- J --------------------------------------- ........................... � Owner's Name... -- ------pffKa=1W---Pere-_petersen---.....• m_ ni.#. Phone-...............&............... 4` Address-----------------_----I............-----•-----.............--......... ----------IV;47v.i'k i1V Iii------ ..................................................... 9� I . 1 Contractor's Name----The_..D.AY..&...X10FAT---Septic..._Tank_.;3e_r_v_iceL------------------------------------ Phone..qq.-6--3.8+1...... 1...... Installation will serve:. Residence [XXXpartment House E] Commercial E] Trailer Court C1 Motel 0 Other 0 Number of living unit.1 Number of bedrooms .-I--dumber of baths _--1_ Lot size ................ Water Supply: Public syste [ZX Community system F1 Private M Depth to Water Table __6Q ft. Character of soil to a depth of 3 feet: Sand F] Gravel F1 Sandy Loam [-I Clay Loam [] Clay [] Adobe ff( Hardpan 0 Previous Application Made:' (if yes,date_-Y----------------) No ❑ New Construction. Yes [] No U-' FHA/VA-. Yes C3 No Qa TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sp,ptic Tank: DistancO,LfroMlne�aresf'wel[*Ng�IRQ--Distbnc74§-fr6hi'fbod'af]Oh.��t.—.Material..—.--- _C----Brick................. No. of �,o,partmenfs----------2 1-------------Size..A11 ...Liqud.,depth8"-------Iapacity. O.0__Gals. -6-�'l- - `,e Joe ug� at, Disposal Field: I Disfanc'ti from nearest well---- Distance ic;n... ---------Distance to nearest lot line______5........ ---------- ength of ead of --1..-.-4Q h---------- ----------...... lu Numberl�of lines------- er i -------�2W Type of,tilter of filter rna'46rial.......18.!!----Voi�l length---1......4W-------------------- __ 1 \4 Seepage Pit: DistancJ'to nearest weIlyN.6JffE'!.7=-Distan�e fro-rn'foundation---- Distance to nearest Id...line....5.f........ Number of pits-----I-------------- Diameter------33 11 •------Depth---- ........... IBX -- ----- qN ------------ Cess ool: Distance from nearest well---- nce from foundati3n---------- --.Lirlipg,material------- - ---------- -i:.:apaci! Size: Diameter--------- -------------I--------------6epf h------------ �1---f I--------liquid 4 1 ------------ N e, .1y----------- -------------gals. Privy: Distance from nearest well------i I -� rest�,16-uilding---I I --•-------------------------------------.-Distant6 from nea ------- =1-.•--.._......---...-•___--. Distance'�to nearest lot line. �o----------- ----------------------------------+-- 4 1 'N I 0 ---------------- ------------------------------------------------------------------ Remodeling and/or repairin'g (describe)------------------------------------------ -- ----- -_i-_ ---t----------------------- ...........................-------------I--------------------------------R-e-placi defu& ___s -'y-st-e me------- ---------------------- . -------------------------------T-------------- ------- ............--------------------------------------------------------------------- -------------------------------------- ---------------------- I ----------------------------------------------------------------iii�� -----------.1.1---------------------------------------------------------- ------------- ----------------------------------*------------------- I hereby certify that I have prepared this appG"fl Wan� that the work will 4e done in accordance with San Jo'aquin County ordinances, State laws, and Dave and iegulafions of�i6san Joaqdin,,Lo4;l',HeaIfh1 District. (Signed)__The---PAY & NIGHT--- ......T. SVC-,-------- --------10WOMil7cK Contractor) ---------------------- --- _Z--- ---- ---- ------------------------------------ By:------------------- ...... 'Itle ------------ -------------* - --- ----------- - ------- (Plot plan. showing-sire of lot, location of system in relation' waII4-buildings, can be placed an reversti side). 'FOR DEPARTMENT USE ONLY X ---------- APPLICATION ACCEPTEDBy ----- .... DATE------- Ii: ------------------------------------ DATE----------------------------------------------------------- REVIEWED BY................................. ----------------------------------- 'i!..... .......... ------------------------------------------------__----_------------ BUILDING PERMIT ISSUED..... __ DATE------------------------------------------------------------- j-+ Cj4 —_ Alterations and/or recommendations:---1- - ------- - ......:50.�. �------ ------ ........Z.,14T.... ........ ------------- :4 ....... ------------------------------------------------------------------------------------------------------------ ----------------------- ---------- ------ -------- ................................... ---------------------------------- --------- ---------- --- -------------- ---------- ................ ------ -- ----------------- ------ ----------------------------- .................................... FINALINSPECTION -------------------------------- Date---- -z -------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 SovIh American Street 300 West Oak Simet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 21A 5.61 ATLAS