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FOR OFFICE USE: -- r ------- ---- --- ----- --------APPLICATION FOR SANITATION PERMIT Permit No. __1_ U_.-`_'-------- ----------------- -------------------------------------- (Complete in Duplicate) (� --.-----__ This Permit Expires I Year From Date Issued Date Issued .- _:^-- ------ 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...........971?--B. Harris St, t Stktn. ----- -----------------------------•--------------- Owner's Name------ ._ Resendes __ - - Phone.._-HD .. 9 Address- ------ ------2,72.7--- Stkr n. ; - , T&1i �erV CESContractor'! Name---------------------•—D-01 ---401 --- --- ...rne------- ---•---------•---------- Phone---HO t....�1915... Installation will serve:- Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __- Number of bedrooms _-_2_ Number of baths ..-.l_ Lot size ----bs---x--_1-4.0--------------------------------- a Water Supply: Public s stem K] ; Community system ❑ Private ❑ Depth To Water Table 35—ft. Character of soil to a depth of.3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[2 Hardpan ❑ \ Previous Application Made: {If yes,date---- -------..) No fit] New Construction: Yes ® 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_------------.------------_-- - t Elaeting No. of compartments--------------------------Size-------•------•--------•--------Liquid depth--------------------------Capacity-----------••---------- r Disposal Field: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line........... ...... Ensting Number of iines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material...........------------Total length------------------------------------------ Seepage Pit: Distance to nearest well----A ------------Distance from found -_ation Ot.._._.._..Distance to nearest lot line—.-5I 1 Number of pits..-11-------------Lining material___rOek--------size: Diameter-.36--.-_-----.--- Depth----2-- �-------------------- I Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-..------..----_-_.------.---------- ❑ Size: Diameter----'--------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--.-----.-----------_-__----_----.-------. ❑ Distance to nearest lot line-----------------------------------------------------------------•-.....-------------------------------------- Remodeling and/or repairing (describe):----Adding---36" 2�-t__-Filter-B_ed__to eX�.stl 4g-- 8ya�em -------------------------------------------------------------------------------------------------------------------------------- - I a - f .-...----------------------------------------- -•--•--------------------------------------- ----•------------•------------------------------------------- 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. I ��. (Signed)----------D 11P: -.A@P: ,C--Talk Service �riC. �---------------------------- (Owner and/or Contractor) By:------F-erry...Q. ...W rthan------------------------------------------------------------------------------(Title) Gen. Mgr- (Plot plan, showing size of 14, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED-BY------------ r ''r'rt" ------------------------------------------- DATE----------- ------------------ REVIEWEDBY---------------------------- - - ---------------------------._.-...------. DATE----------------------------------------------.......... .--. BUILDINGPERMIT ISSUED-----------------------j------------------------------------------------I................----------- DATE--------------------------------------------................ Alterations d/or ecommend'atio :------- _- ------------------ ........... .. - ------ ---- --------D_l ---- -- �.. .---..... ....... 4C, ------------- ----------------- ---------------- -----------------•--------------------------------------------------------------------------------- - ! --------------------------- ..................---------------------------------------------------------------- ---------------------------------------------------------------------------------------•--...-..--------------- FINAL INSPECTION BY:.----- .... .....---------- — .rte.., Date------------- ._..J" ,----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamor►Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tray,California ES 9 REVISED 8.59 2M 5-62 ATLAS