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3.3 APPLICATION FOR SANITATION PERMIT , (Complete in Duplicate) 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. JOB ADDRESS AND LOCATION_----- r C o � � Cg f✓ _�tk�' Owner's Name------8-• ------- *-1 -_ _ ( ,------------------------------------ ------------------------------------- Phone------' e---7--t/---------- Address--------------` g - --------A-C-- Contractor's Name----------------Ca_D.----L,-U--W R --4--------------------------------------------------------------------- Phone-2--299Y--------------- Installation will serve: Residence r, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedroomsA Number of baths [Z Lot size------- __i____________________________` n Water Supply: Public system 10 Community system F1 Private E] V Character of soil to.a depth of 3 feet: Sana ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe (& Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material-------------------------------------------------- No. of compartments Capacity _-Size-------------------------------_Li depth--------------------------- Liquid de ❑ P p Y----- - - - q P Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 1771 Size: Diameter-------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F1 Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter ----------------------Depth --------------------_------- DisposaField: Distance from nearest well______�r-.Distance from foundation__ __.W_-----Distance to nearest lot find -------- Number of lines--- 1. ___ ________ _Length of each line_________ p---_---- __-Width of trench____ - �- �, ,,`t-'�-------------2222-- Type of filter material_ _ Depth of filter material_____��._______ t Remodeling and/or repairing (describe):-------------------A-Q-D---- -----------0�--•-------Gt'` "------- '-9111---- ------------------------------------------------------•----------------------------------_----------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 ruleeland regulations of the San Joaquin Local Health District. __ a` . (Owner and/or Contractor) (Signed)-.--2222-• --- - - - --- ---------------------------•----------------------------------------------------------- BY:-------------------------------------------------- --------- --------------------------------------------------------------------(Title)------------- --- #---------- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- -- DATE------------y - f : - - ---- REVIEWEDBY---- 2222----------------------------------------------------I------------------------2222-- - -- -222222 22---2222-- DATE----------2222-- - - - - BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------- ,k ------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------`----------------------------------------------------- PERMIT No----33.6---------- ISSUED------�-e;�-_/57---------(Date) FINAL INSPECTION BY:------------W--.)---- '---------------------------- Date------------------3- --3---------3—l SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2M 9-50 W-1639