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�\rrlAPPLICATION FOR SANITATION PERMIT Permit No. rivja/ (Complete in Duplicate) pate Issued ,lx7r!sr 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. 5 9. JOB ADDRESS AND LOCATION__. 337._So,. Ma . 'a__S. Phone----"'Stockton---------------------------------------------------------------- ---------------------------------------- ---=------ `--'-•-------------------••--- Owner's Name---_-------CrTBgQY'_i4_. Sgar.& ----•-------•------- Address--------------Rt••---3...$OX-----8j- ----y------St-oCk-ton--------------------------------------------------------------------•-----------• Contractor's Name__DAY--&--IN1G_ffT---SQPt-i0---�ank-- -ez'v C_B---------------------------------------- ------- Phone...-15Q------arj--(:46---- Installation will serve: Residence IX Apartment House 171 Commercial E] Trailer Court ❑ Motel ❑ Other ❑ 1-- Lot size ------50!---X__12.51-------------------------- Number of living units: __�___ Number of bedrooms _2---- Number of baths __ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _30Fift. Plus Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam El Clay E] Adobelm Hardpan ❑ Previous Application Made: Yes ❑ No [X, New Construction: Yes ❑ No = FHA/VA: Yes El - No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: l w (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___+ ---- -----Distance from foundation__________________.Material_________________________.______-____._.______. E30st ing No. of compartments------- -----------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- e Field: Distance from nearest well___None--Distance from foundation______ Q�------Distance to t nearest lot 4!ine______ !______ Number of lines------1------------------ -"---Length of each line-----3Q!-----------------Width of trench------ -------- E )sting sr Total length------30------------------------ -- Type of filter ma#erial._�Rp��C-----Depth of filter material-18" & ADD; KK Q Seepage Pit: Distance to.nearest well_____________1___-.Distance from foundation_-- Q�--------.Dis�anc Distance nearest lot ,-----_ ___._.._ Depth 20 r.. Number of pits-------I------- --- g "� _ Linin material iometer__ - Cesspool: Distance from nearest well------------------Distance from foundation____- ____'_____-_..Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth th----------------- -------------------------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well __!--------------------------- ----Distance from nearest building------------------------------------------� ❑ Distance to nearest lot 1ine----------------------------------------------- -------------- Remodeling and/or repairing (describe)_---_---------!`SUPP_LEMENTA Y---DRATNA,GS----------- ---- ----- -- ----- ------------------------------- -- ------•------------------------------------- ----------------------•-------------------------------------------------------- --------------------------------- - - - - - 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 Joaq in Local Health District. (Signed)-------DAY__&--11iZGHT---Sep _ c--Tank---Serve (09OK� Contractor) - _b__ -------------- ----- ------Tale --------- -- --- -- ---- - - ---------------------------------- (Plot plan, showing size of lot, location of system in relation t ells, b--uildin s etc., can be placed on reverse side). FOR DEPA TMENT USE ONLY DATE ------•---�-- - I APPLICATION ACCEPTED BY--- ----1_!1 ----------------- ------------------------- -- --------------------------------- DATE------------------------------------------------------------ REVIEWED ATE------------•------•---------------------------------------- REVIEWED BY------------------------------------ ----------------------------------------------------- -------------------------•----- 'DATE•--------------------------------------- -------------------- BUILDINGPERMIT ISSUED--------------------------------- ---------------------------------- Alterations and/or recommendations---------------------------•-------------------------------•-----------•-------------- ----------------------------------- -------------------------------------------- ----------------- v 3' - ----- - ---- -- 7--k ------ ------•--- ----------------- _ ------------- ------------------ -------------- --------------------- ------------------ ---------------- ------------------------------ FINAL INSPECTION BY:. ------- --------- Date_ .' - --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street i32 Sycamore Street 814 North "C" Street 130 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y, ES-4-2M , Revised 1.57 F.P CO.