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FOR OFFICE USE. y APPLICATION FOR SANITATION PERMIT Permit No. .. _ [Complete in Duplicate) Date Issued .... --------------------------------------.--------.--------- This Permit Expires 1 Year From Date Issued Application ishereby made to the San Joaquin Local Health District for permit to construhand install the work herein described. This application is made in compliance with County Ordinance No. S49. i - r JOB ADDRESS AND LOCATION-----2392_-E-. _.Wi11ov--Z.tr:eat-------St.00ktaa-----------------•---_------------ . --•-------------- "-= Owner's Name----------------------------------------KlDel--Stll1vn------------------ F Phone_- HQ---5772------- Address-----------------------------------------------------$Ame......------------------------------ =------------------------------------ -------------------------•------------- --------------------- Contractor's Name----`The---BAAY.__&__1UGHT'---Sad.]tic' 'Tax3k__S -rV1-C-e------------------------------------ Phone--- 0.2-_7Q)+_6--_--- Installation will serve: `Residence MC Apartment House ❑x Commercial ❑ Trailer Court ❑ Motel ❑ Other`❑ Number of living units: 1___-- Number of bedrooms 2----. Number of baths ----1. Lot size _60.1_--1--13Q!------------------------------- Wafer -__---_--- --------------Water Supply: Public system =Commuriity-system ❑ Private ❑ Depth to Water Table 6O--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑. Clay Loam ❑ Clay ❑ Adobe IC Hardpan ❑ Previous Application Made: (If yes,date---'----------------I No = New Construction: Yes ❑ No FHA/VA: Yes [I No E]TYPE OF INSTALLATION AND SPECIFICATIONS: a =,. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) # Septic Tank: Distance from'�nearest-well-Hone---_Distance from foundation--: Material------�-QXJ,CTete---------------•---• No. of compartments-----------2-----------_Size---•5-6u_ .S 6u_ Liquid depth_-.-_.51�t-----------Capacity....8QQ_--Gals a ( Disposal Field: Distance from nearest well.-jljQ ----lTistenn�erfrom foundation.....lO-1-'_-_."Distance to nearest lotline----- -! JMX Number of lines_----1---------------------------Length of each line---.------9-Q. _-----_'---..Width of trench------- --- -----_--- I Type of filter maternal-_--S-e_p-o---Rk*Depth of filter material--_'_:__.18�� -----Total length........ _=--�r_ ---------- f Seepage Pit: Distance to nearest well---None-------Distance from foundation_---- a.Qt_.~__.Distance to nearest lot line----- ----____-. iftNumber of its- ` material--Raok--_------Size: Diameter-_-_--- rt P �.= Lining' -- -------Depth-=-- �] Cesspool: Distance from nearest well-----------------Distance from foundation---:--------------_.-Lining material--------------------------.---_-----_-. ❑ Size: Diameter-----------------------------------=Depth-------------- ---:---------------------------------Liquid Capacity-_------------------•-----gals. N Privy:t Distance from nearest well well-- ---------------- ..-_i-------------------- -----------_---- T#-_mDy ist..anYce from nearest building---------------------------------- - ,--. --------- -- ----- - ------------- ---- --------------------------•----- ---------- .-. ( ❑ Distance to nearestlot.line------------------ Remodeling and/or repairing (describe):--- -------- --- ------------ ------------------------------------------------------------------------------------------------•-----------------•--- ------- -----------------------Rep-lacyiii---existing---defla.n t---system;--------•------ --- 1 A s :. I I hereby certify-that I have prepared this application an A the work will.:.be.done.in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaq in Local Hea A istrief. f (Signed)------ he DAY & fijH SS3 l :'�'ajj�L�e ce - ` ? -------- �ontractorj t F. .� Title = 4':' ------- -- -- Br• ':.:•-------------------------------------------- -------------------- = (Title) ` (Piot plan, showing size of lot, locafion of sysfem,in relatio to ells, buildings, etc d`an-6e placed on reverse side]. a . i OR DE TMENT USE ONLY APPLICATION ACCEPTED BY--- .- s;^^ -- -------� ----�---------- ---------------••-----------------=--.5-_•DATE-------�= -• - --��---�------------------ REVIEWED BY-- BUILDING PERMIT ISSUED---------------------------------- { DATE -=---- DATE------------------------------------------------------------- -----------------------------------and%or recommendations:-- __—-_ -----"- ^-`'--'-_-- =__-_- --------• ------------------------- +: ..- s =--------- ------------ - Wit.- ,�-�� • __ , _ — -� p -------•---- ----- .. = . ,. -- FINAL INSPECTION 'BY: --. --C- 4 .FwDate_ _x --------------------------- F M - SAN JOAQUIN LOCAL-HEALTH DISTRICT d 30 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EG-9 REVIMEO 8.59 F.P.CO.2M 6.60 -.