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FOR QFFICL-U5C:.� L_ __________. APPLICATION FOR, SANITATION PERMIT Permit No. ................... -------------------- ----------------------------- (Complete in Duplicate) /G Date Issued -----------�6___---_F,----------------------------- This Permit Expires 1 Year From Date Issued ............ ..�.� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION. ... 403.E' Main Street-� $toc��to�----------------------------•------------------------------- Owner's Name---------Se r' e PePnybaker----------------------------------------------------------------------------------------. Phone-..--------------------------------- Address-------------------- 1.J�22 WA r�° ... tr< e .;_.-5-t;-Qr-kt-an-------------------...---------------------.---------------------------•-----_------ --------- one.. --- ' Contractors Name-��?.�.--PAX'.---�--�'�Cx�---�-�-��-�--C---Tc'�.�.��.-��r-�ri��------------------------------•-------- PhH@ 2-��=�------ Installation will serve: Residence ❑ Apartment Douse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑** Number of living units: -_.-a Number of bedrooms --- Number of baths 0_---- Lot size ------ 2- f x 2 � 1 Nater Supply: Public system [ZXCommunity system ❑ Private ❑ Depth to Water Table __6Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ,Clay Loam ❑ Clay ❑ Adobe IM Hardpan ❑ 'Previous Application Made: (if yes,date--------------------} No ❑ New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No ❑ TYPE OF'INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-NOne----Distance from founclation__�0-t_--___.Material---CC___T3r1ck____-____- ------- ❑ No. of compartments----- - Size-5 t1_ I.--gcabuquid depth-----65!---.--_--_--Capacity----35-0.0.-_fir__ ---- y"Disposal Field: Distance from nearest well_NOnp lrogiVaPion-__-.1 C-_T-__---.Distance to nearest lot line__- _t_--.._.- xx Number of lines L n #+h rlac dine- Width of trench . Type of filter material...$gip_.-_Rk-Depth of filter material_---- _----.-.-Total length--------3N..............------------ L Seepage Pit: Distance to nearest well---NO?•E) 'Distance from foundation____qP......_-..Dstance to nearest lot line--._.-_�'_t-- Q t T z ' Number of pits_ --b-------------Lining material-,RS}�%.1�--------Size: D,ameter----------------- -----Depth-------------�....------------- Cesspool: Distance from nearest well-----------------DislFance from foundation--------------------Lining material-------------------------------------- ❑ Size: Diameter--------------------------------------Depth---------------------.---- ---------.-Liquid Capacity-------------_-----------•gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot iine--------------------------------- ------------------------------------- ------- ---••----------------•----------------------------------- rQ-?�.Q e lf.__�erlr? - lkn--- ro t-:----- ?0---� P--• --...- Remodeling and/or repairing (describe):__'�"Yr..- - � Tl >_Ltput--_b_e.12.g---a-.1�Z.A.K:LI47_M..o ---35-Q0--��an.�• ��^-.-c�_��-----but---�]Ze aVI0na.9_e---beim under 30-0-0-- Gal�- � ---------------------- -----r_------ -k- --� --- ----- A _ = = - 1 hereby certify that I have prepared this applicat and tha�f-the work Hili ado in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)__14e DAY NIQG S.eDt,lo--_Tank_ _moi e---- =- - (0cYii2{-WiY.Contractor) ti By:-------•----------------------------•-•------------------------------- ____ _ �.` {Title) {Plot plea, showing size of lot, location of system in rely to wells, -b--u- ings, etc., can be placed on reverse side). ". FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ ----------------- --------------------------------------------- DATE---------- �� rE$�----------------------- ' ------------------- DATE BY------------------------------------------------ - ---- --- - - - - -- - -- ----------- ----...-•--••-------------------- BUILDINGPERMIT ISSUED------------------------------- -----•--- -------------------------------------------------.-------- DATE------------------------------------------------------------- �•.: Alterationsand/or recommendations:----------------------- --------------------•--•--------------••-------•----••---------•---------•-----•-------------------------------- - _ 4! , ::-- - it.t_�-__.p, --- , A-�-- T +�J .---�I -------- ---------------------- , FINALINSPECTION BY:---------------------------------------------------------------- Date--------------------------------- ----------------------------------•----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Ee-4 AEVIEEo 13-50 F.P.CO.2M