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APPLICATION FOR SANITATION PERMIT Permit No. _00.0---Q-,-- v 7- (Complete(Cplete in Duplicate) 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. 824 South Netherton St., StoCkton. JOBADDRESS AND LOCATION------ - ---- ------- --------------------------------------- ------------------------------I----------------- --------------------------------------- . P, Pennebaker 274273 Owner's Name-------------------------------------------------- ---------------------•-------------------------------- ------------------------ Phone •- ------- ---- ______ ___ - --------e 1122 = Rose Street ---------------= Address----------------------------------------- Contractor's Name-------------------------------- Inc, ----------------------- Phone---9-9607 - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ �5 Motel ❑ OCta er eSalon Number of living units: -------- Number of bedrooms ________ Number of baths .------- Lot size _____ _________ ____ _ _________._.____.--__._.__._ t Water Supply: Public system X Community system E] Private E] Depth to Water Table 4- ft. Character of soil to a depth of 3 feet:'`Sand ❑ Gravel ❑ Sandy Loam ❑- Clay Loam ❑ Clay ❑ Adobe (X Hardpan ❑ Previous Application Made: Yes ❑ No X] New Construction: Yes Pg No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu6liVSwe6� ay f?4I��ifWq_200 feet.) L.LSeptit Tank: Distance from nearest well50...........Dista c afro fou dafon_8 ______________ �r.ial_ C Brick Q=om Z Size__ �t___-e � Li uid de th__--------------------------Capacity Ca acit � ----7� g•� IN No. of compartments-------------------- t�.�E .' q i? -- p Y--------- - - ----- 1 :4' � � g----- lO t 7l� Disposal Field: Distance from nearest well_________________Distance from found tion___-____________.Distance to nearest o �me_______.___._.._ Number of lines---- _________________Length of each line__fy27 j et__ l1¢dlth of trent 1 eft 61 a, holes. Type of filter ma --Depth___.---Depth of filter material-----------------------Total length_ art--_-_��_�____.____-- Seepage Pit: Distance to nearest`well___________________---Distance froBmxfou dation____________..____�igance to nearest 1000--- .._ CC ® Number of pits----------------------Lining material- - ---- --k5ize: Diameter ----------- -----Deptn--------- + Cesspool: Distance from neatest well-----------------Distance from foundation------------------_Lining material-_.____.._.___.____. _____. I Size: Diameter------ I------------------------------Depth-------------------------------------- -------------Liquid Capacity----------------------------gals, 1 } ______._Distance from nearest building Privy: Distance from nearest well g ❑ Distance to nearest.loft line---------------------------------------- ------ ------•-------------•----------------------------------------------------------------------- I *City water in use. . Well to b., abandoned. Remodeling and/or repairing (describe).,--------------- -----------------------------------•=----•----•-------------------------- ------------------------------ •------------------------ i I --------------------------------------------------------- r -----------------..--------- --------------------------------------------------------------- --------------------------------------- i 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. s ------------------------ ------------------------------------ Owner and/or Contractor , (Signed)------------------------------------------------------------- --------------------------- - - { / By:--------------------------------------------•-- f----------------------•-------------------------------•----------------------------(Title)------------------------------------------------ -------------- (Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- ------------------- - ---------------------------------- DATE------------- -------------- REVIEWEDBY--------------------------------------------------------- ------------------------------------------------------------------• DATE------------------ --• --• ------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:---------------------------------------------- ----------•------------• ---------------------------------------------••------•------------•------------------- ° ---------------------------------------------------•------------'--•------------------ •---------------------------------------------•-------._. .. I f -------------•------------- ------------ ---------------- 1 Date------------------) ---------------------------- FINAL INSPECTION BY_____________ _ _ _k.__�_4-. f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Sfock+on, California Lodi, California Manteca, California Tracy, California E5-9-2M 0-52 Revised W-2100 -..