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' APPLICATION FOR SANITATION PERMIT Permit No. {Complete in Duplicate) Date Issued ----___ 7 _ 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---------------- 2.511 E-*-- Lafayette- St........-+---Stockton------------------------------------------------- Owner's ------------------------- - - ------------------- ------ ]rdOCk------------------------------- - Phone----H� � -------- .Owner's Name--------------------------------------------- --------------- ---- - -- Address - ?-r712..E`•--:-afay-e-tta------------------------------------------------------- Contractor's Name--_-__DAY--&---NHT S-.--- ...... .------------- -IG- -- T -VG- -- ---------------------------------- --------------------------------------- Phone----HQ----2-7�------- Installation will serve: Residence [$ Apartment House E] Commercial E] Trailer Court E] Motel L] Other [-]4 Numberof living units: -1--- Number of bedrooms -3--- Number of baths ---I-- Lot size ------541----x---flat-------------------------- Water Supply: Public system [ ' Community system ❑ Private ❑ Depth to Water Table __50 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe DM(Hardpan ❑ Previous Application Made: Yes ❑ No ❑K New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No EX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance froln nearest well-----------------Distance from foundation-------------------Material-------_---.---._-------------------.._.---_--._. E' [Xisting No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well---NOAB__Distance from foundation----2Q_t-------Distance to nearest lot line---6I.---__.-. E3p[stin Number of lines---.---1---__ - g 3 tt . g - --- -----------Length of each line----- �t-------------_.Width of trench-------�-------------- ----------- t } & AJC Type of filter material__S fiEtle__---Depth of filter material----- Total length-------3Q--_f t------------------ N pCLA Seepage Pit: Distance to nearest well-----NQ OM-----Distance from foundation -10 to nearest lot lin e------61------ = of Number of pits-------------------Lining material----Rla_Ck-----.Size: Diameter------33-----------.Depth-----25 -------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------- ----.Lining material-----..-.-_-_-_-----__----__--__----_ ( El Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. , Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildm ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------- -----g---------- ------------- Remodeling and/or repairing (describe):__-_____*'1_`___'S_u-- _le1DE'n�2EI' D�'a t--a e e --y --- ------a 1 -------------------------I---------------------------------------------------------------------------------------------------- -------------------------------- -4 -----------------------------------------------------------•----------------------------------------------•-----------------•-------------------------------------------- 1 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfy P ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 DAY & NIGHT SEPTIC TANK SERVICE Con+ractor (Signed) ----------- -- -------------------- - ---------------- -- ' -{ BY 2-345-E• MinE-''i--AVe_�_.__.HQ--- -70 6-- i {Ti+le} ------------------------------ (Plot plan, showing size of lot, location of system in relation to Is, buildings, c., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- awl u ±ll-._�.9hJ---- -- -------------------------------------- DATE------------- ---- ` REVIEWED BY--------------------------------------------------------- 4* DATE 1 ' BUILDINGPERMIT ISSUED---_------------------ - ------------------------------- DATE------- 1--------------------------------------------- Alterations and/or recommendations---------------- ------------------------------ ----------------------------------------------------------------------- ------------------- --------•--------------- ---•-----------=------------------------------------- ------------------------•-----------•--- -------------------------------------------------------------------------- -----------------------------------------------------------------------•----------------------------------•------------------ --------------------- FINAL INSPECTION BY-------- -----------•---------------- Date - ------- ------------ ------------------------------------------ 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.