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FOR OFFIC USE r APPLICATION FOR SANITATION PERMIT Permit No. .. 1.. -_7. .Y ------------------ ----------- -------- -- (Complete in Duplicate) 1 � 1 " Date Issued .._..__�_..._�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 described. This application is made in compliance with County Ordinance No. 549, e JOB ADDRESS AND LOCATION545North--WATT$-,( yE,,.:nSTOC.KT.ON.r...GALIF-QI�NIA.........•--•---------------------------------- Charles And Chrystal�Jadkeon . r - ' Owners Name ---------- - - PhoneHQ.-1E-��'.� �tt�okton______�`i ala-o-1'x1js .._______________;_-_______._____...._.....___......_......._____._....___ Address-----54�---N•ar�th---Ws��s---�4$$ --------------- - DeltaContractor's Name--------------------15?P'I;a1D....'L'aAk.-.dei'"_g'1_C-e---Ina.---...--------------•--.._._..,----------------------,PhoneHfl-3-3g53------... , Installation will serve: Residence I� Apartment House ❑ Commercial ❑ Trailer Court 6 Motel ❑ Other ❑ Number of living units: _I____ Number of bedrooms ____2_ Number of baths __l--_- Lot size .------5O _-- 225 l ' Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water`Table ___'--5 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam El Clay Loam ❑ Clay ❑ Adobe[3 Hardpan ❑ Previous Application Made: (If yes,date___________ _______) No E3 �kNew 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 J4,Pri Distance from nea�st well___._"-______Distance from foundation------------_.......Material-------------------------------....--------------- ❑ �O. of compartments--------------------'-----Size--------------•--"/-----------Liquid depth----i---------------------Capacity---•------------------- Disposal Field: Distance from nearest well_______________ Distance from foundation-----------.1_.....Distance to nearest lot line................. (� axirting Number of lines---------------------------------Length of each line----------------------i------.Width of trench._-. _--,_..------------------ **! Type of filter materia--______________-------Depth of filter material ;_��t------fot-a"l -length______________!_____-_________________ ___-_•__ efSeep T-- Seepage Pit: Distance rest well None foundation-Ample_Distance to nearest lot line....5t__-_____ Number of p = gmafe al __—.X--_---.-Size: Dia'meter'---3-611 Depth--25-1 y )5$&x s Cesspool: Distance from nearest well-----------------Distance from foundation----------------1---.Lining material..____"___________'________________- ❑ Size: Diameter--, -- ----f-------------------Depth-----------------------------------------------€---Liquid�Capacity------------------------_--gals. Privy: Distance from nearest well--- ________________________Distance from nearest building------------.---------. ❑ Distance to nearest lot line------------------- S Adding seeps a pit to existin s stem ' Remodeling and/or repairing describe):----; �._.._y-. .._.. -- _................................. �, �p }� ------ -- _____[�' 1�!�x'.___'-------___"_T_____________ __ _ _ _ _ _____;"C.. - _ '�+•4� ..__ _ __�____ "1__ .7 I �.141+CS�" ____________ _ ------------------------------------ ------------------------------------------------ ------ -------- ----•-••-- ....... ----------•----•-••----------------------------------------------- -------- ---------------------------------------- --�'� ....._------•--•-- ----y - - ---------------- ----------------------------------------------------------------------------------------------�-------------- - I hereby certify that I have prepared this application'and that the work will be done [n.accordance.with San Joaquin County ordinances, State laws, and rules and regulations of the Sen Joaquin Local Health District. (Signed}-----Delta-- ept e 5 __ er�r�i.Ce. �nc.----------------------------------------------------------------------(Owner and/or Contractor) ci By:-P_ O--Wartha,n-.._4------------------------- I-----------------------------------------------(Title)-_..I AD.. (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can be placed on reverse side). N,,,FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEC',BY--------------------------- - ------------- DATE--------- -------------- -- REVIEWEDBY --------•--- --------------------------- DATE--------- --•--•-------------------------------------------- BUILDINGPERMIT ISSUED-------e-`--------------------------------------------------------------------------------------- DATE--------•---- -------------------------•-------------------- Alterations and/or recommendations: _ ------ ------"--- ------------------•-"•---------------------------------...-_.-......------------------------------------•- 7,- - d- -4z �------•- �a a r'". ---1--fhk lC ° `xt'� . ..-.-•--•------------------•----"--"-----------------------•--•----------- ---------- -----1 --------------------------------------------------------._..... --•-••---------------------------------------------- -------------- --•---•-•----•--•-------------------------------- --------------- ------------------------------ -------------------------------—- ----•---•-----•--------------------•--•----•-•-----•- ------------------------•----------------------------•---••------ FINAL INSPECTION BY:---0........ Q.- --------------------- Date-- -'' r r ..........---------- ---------------------------- SAN ----•- •---.._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 Co.,REVi9G0 9-59 F.F.00.SM 6.60