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y--� APPLICATION FOR SANITATION PERMIT Permit No. ..... 7 _.... 1,I .� [Complete in Duplicate) O r�o Date Issued Application is hereby made to.the San Joaquin L'"ocal 'Health District fora-permit to construct and install t e work herein described. This application is made in compliance with Counfy_Ordinance No. 549. Northaide OfR$ Front, 1a• ��.Z.. -ice ter€ ST- FRONT Street ust east of Ione Street LINDEN J B ADDRESS AND LOCATION---- �--e -- - - t n l -------------- ------- ------------------------ Owner's Name--- -*---Na�cet'I�i�---- - xi1-;�-- ,pnt '_:---T-•----A- --powers- ---Const ,---Co HO__ 55791-------- • Phone Address--------------337---��— Ash ;atrEsti - _o�ktQn----------------------------------•---------------------------•------•---------------------•----------- - Contractor's Name------TDAY---&:.NIf'xHT_'_SEE1'_C---'�ANK__5ERV1-0-•-------------------------------- Phone-HO_-2701+6- • ---------- Installation will serve: [Residence partmen House E] Commercial E] Trailer Court n Motel ❑ Other El Number of living units: __3,___ Number o bedroom`s _=i ___ Number of baths ___�,.__ Lot,SiZe ______ ��--_X--200-1-:----------------------- Water Supply:—PublicI system T-1 Commursity system E Private ❑ Depth to Water Table _4o1ff., Character of soil to a depth of 3 feet: Send ❑ .Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay ❑ Adobe M Hardpan ❑ Previous Application Made: Yes ❑ No Z- New Construction: Yesx] No ❑ FHA/VA: Yes ❑ No [X TYPE OF INSTALLATION AND SPECIFICATIO.NS:, [No 'septic tank or`cesspool if ublic sewer is available within 200 feet.} _. P `ice...,,.,,.- P. permitted.,. �pr,..._.r........,w.,..,.=y......�,.......�, r Septic Tank: Dis ante from nearest well----NA316'Distanc`e from foundation_____10 ____-Material---CC___Br t! --_-__-------------- No. of compartments---- - ----------------Size__5:R!=-X3&!--_X__:Liquid depfh-_58t�-`'� `-�-----Capacity_....--800---QO Disposal Field: Distance from nearest well_.NOne....Distan e from Undation-----l9_t-------Distance to nearest lot line____IQP____. YP ------------ - ----- ..ne----------50-t-------='----Width.of trench--------2`- 4---------------------- Number l �e of filter matenaL__sS_G_ Iu :C-___Dench off flfiehmlateriel:____:__]$fit------Total: length-----------5Q__fts___:_____- Length Depth Seepage Pit: Distance to nearest well Nom$____-----Distance from founaation_..._7_(Q!_..___.Distance'to nearest lot line----IO'__.__ Number of pits_'_1__:-____-""=-Lining`material'__R_ock--------Size: Diameter----33---------------Depth__ -A_20-t----------------- Cesspo ~ I ol: Distance from nearest well________________Distance from foundation--------------------Lining material------, __.________._________.___.__ ❑ Size: Diameter------------------------ -----=----Depth----------r--- --- -------- ---- -----------------Liquid Capacity- ---=-"-------------------gals. , d F ' Privy: Distance from nearest weEl---_-------------_--------------------- Distance from nearest building_°°�___"-- __ _ ---_____________.___-_____ - ❑ Distance-to-rearest lot line--------:- ----- �- --- ". l --------------------------- { � l Remodeling and/or repairig (describe):______'---- ---------------------------------------� --------------------------------- ----_•-- --------------------------------------W -------- ----------------------------------- ------------------------------------ ------- ------------------------------------t----- ------------------------------------ -------------- ------- _--•-- -- -- ------------------ 1 hereby certify that I have prepared this application a that the work will b done in accordance with San Joaquin County ordinances, State la ru s and re ulations of the n J a in L a ea District. " ►Y c N(NPT ` I SEPTIC TANK.--$ERVICE ;-- ---- - ------- [� Contractor) .. f(Signed 3f1�`f:Niirier:Ave.--- Plot + '•Stockton 5,'Callf. ;'(Title) = Y� Hl~}MI �. } ------------- ( plan, showing size of lot, location o� system in rale!' n wells, buildings, ., can be placed on reverse side].. ' i FOR ARTMENT USE ONL ` APPLICATIONACCEPTED BY----------`------------------- - - ----------- ------------------------------------------------- DATE-----------•--(J[ y -REVIEWED BY---------------- ---------------------------- ------ " - -------- --------------- "------------------------- DATE----- ATE---- -------------------;---------------- BUILDING PERMIT ISSUED-------------------------------- ----- --------------------------------------------------- DATE , f Alterations and/or recommendations:------ -----------------------=-----------------•-------------•--------------------------•----------------------------•------- ., .... --- ------ -- ----------------------- --------- ----------------- i ---�--- - FINAL INSPECTION BY:---- Date----------- =" == 75AN JOA4 UIN 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-4-2M Revised 1.57 EP,M