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�\ APPLICATION FOR SANITATION PERMIT Permit No. ._ s__��-y.__ (Complete in Duplicate) i Date Issued Application is hereby made to the San Joaquin Local Health District fora ermit to construct a This application is made in compliance with County Ordina ce No. 54 p nd install the work herein described. 11 JOB ADDRESS AND LOCATION------- +r_ _ _ _ - _. V _ -s-1 �� Owner's Name �'-�' �' ' {--� M -- ��'d' --.-. Phone Address__... q ---------- a ��'jf L.I_----pvyne---------------------- A rP- -- Contractor's Name----_ fit_/-__r€_l` - !R y C 1' 4 -' -----skitom---------------------------- Phone - --, Q �- Installation will serve: Residence EqfApartment House E] Commercial F1 Trailer Court E] Motel El Other E] Number of living units: -]----- Number of bedrooms �,.d___ Number,of baths ___[___ Lot size ------X0 --( (}-(-------------------------- Water !WaterSu I Pubic s stem I ply. „y �Community�system _❑ Private ❑ Dep to Water Table -1 �ft. Character of soil to a depth of 3 feet:' Sand ❑ Gravei ❑ • Sandy Loam ❑ Clay Loam ❑ � Clay ❑ Adobe E2rH6rd0an-l] Previous Application,Made:—Yes-L]_No,[a] ::LNe.w_Constr_uction:„Yes 2!:�No ❑ FHA/VA: Yes ❑ No [j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is availabl ewithin1200 feet.) Septic Tank: 011 Lance from nearest well-14fsKe----Distance from foundation__1s f______. Material-__ ------_ [ ' 1�10 aof compartments--- ---------------- 5ize__e��_y_ _�� Liquid de th_4 ri r. 9 R - -- Capacity 8 + --------------- fz C!e��% a .,,r r Disposal Field. Distance from nearest--we-1ITOo:tm-e:-Defiance from}`oundation__-_!_CI__-_ .___ _ Distance to nearest lot line______,?____... Number of lines •[`y�-� `yN� st lines_ f _ ------Length of eacha.. trench--.---.WWidth of .----- aieiaTYpe of filter ma_tet_Dep of filter. L ______Total length- ; "�ar - -�.-_�--_`'-_ -__-_�-___-"-_yeer,Seepage Pit: Distance to neaFest �ell_ �-0l�+f___bistance from foundation__�i__(.._--.Distance to nearest loine_umber fmaerial__-PVCSize: Diameter__ 1-ty______."__.__ g e th �D __.___ ___.. AJ-0 --------------- Cess ool. Dista6ce'4§ 'nearest well--_______}__-,__Distince from foundbtion--------------------Lining material______" ._. - ------------------------- ❑ Size: Diame er ------- ------------ ----------Depth------------------ -------- --- -- ------Liquid Capacity----- --------------------gals..\. Privy: Distance from nearest well-----------------------"___-__-_----__--_-____'D tante from'nearest building--_________--___ ❑ Distance,to..nearest lot line------------ ----------------- --------- } �- --------- Remodeling nd/or repairing (describe)------------------------------------------------------------- --=--------------------------- -------------------------- } ----- --- ---------_`----`-----`---------------------------�•• :. -- --------------R--R ____________________________________________________________________________________________ _ _________ ___________ _______-_-_____________--___-___-________--____-________.._-__-____.__--_ .__...._____- ;. x I hereby certify that I have prepared this application and that the work wk _ ill be done in accordance with San Joaquin County ` V ordinances, State s nc crulls l re +lations of the San Joaquin Local Health District. SEPTIC TANK SERV_ ICE-..---._;__--"-- (Signed�9C&E.-Mirfjyt Ave..--ti__Stockton 5, Calif. ------ ----( '" Contractor) -- -- -------- --- -- gY: :1-1OdfE 2• 06 -- ------- 'J (Title) ----------------------- (Plot plan, showing size of lot, location of system in relation t ells, buildings, ., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------- APPLICATION ACCEPTED.BY------------- ------ ----- ------ -------------------------------------------------------- DATE--- = REVIEWED-BY------------------------ = ---------------- ---- ------------:-------------------------------------------------- DATE---- ----- BUILDING PERMIT ISSUED____________________________-_"-- --- --- -- J . - ----------------------------------- DATE -------- --- ---------------------------------------------------- - Alterations and/or recommendations------ - ------------^_-1---------•-------------------------------- ----------------------------•-----•--------------"-•------ _... ---------------------•----------------------------•---------- --------------•-•---_------------------------•-------------- .-....................-----------------"---------------------------------------------•---------------------- ------------------------- -- ------- � ---------�----- -----------•-------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:. Date-` -- " ---------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Y 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P.CO. t