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APPLICATION FOR SANITATION PERMIT Permit No. „�_/ ....... (Com lete in Duplicate) x 3 P Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe ; This application is made in compliance with County Ordinance No. 549. : JOB ADDRESS AND LOCATION----------------------230.3---E-l---k1P-1M-------------- ----- -- - t ` Owner's Name----------Bill...Caat&---------------------------------------------------------------------- --------------------------------------- :d Phane 3-s�a-�� --- Address. 230.3 k-41g3S]e Contractor's Name-----------D0.It ------------------------------------------- ............................................................ Phone-----.3-3455........ Installation will serve: Residence ❑ Apartment House ❑ Cggm �- L Trailer Court ❑ Motel ❑ Other a ;C-ab3*0 Number of Living units: -3_._. Number of bedrooms .__�'_.�N e aths ___ 'Lot size ......... QX100 --_•__ _-__._ Water Supply: Public system ® Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan (;I; `I Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No Ea 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................................................. EXIST:MG No. of compartments--------------------------Size----•---------------------------Liquid depth-----•--------------------Capacity •--•-----•---- : Disposal Field: Distance from nearest well--------• Distance from foundation--------------------Distance to nearest lot line------ . EXI$`�TG Number of lines-----------------------------------Length of each line..............................Width of trench. __ Type of filter material....._-------------------Depth of filter material-----------------.....-Total length---------.-------------------------------A See age Pit: Distance to nearest well.. 100..._.__Distance from foundation....2.............Di'st}ance to nearest lot line ...5 ] Number of pits_____-1............Lining material-------ORIAX-Size: Diameter....... ..:-------Depth.......251 ----.__._...� Cesspool: Distance from nearest well.................Distance from foundation....................Lining material..._................. ....--..._.._-,,.- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------•-----Liquid Capacity...........- ----------- Privy: Distance from nearest well ______________________________------------------Distance from nearest building........................................... ❑ Distance to nearest lot line.................------------------------------------------------------------------------•-------------•----------------------------------- Remodeling and/or repairing (describe):......ZnJ1%#r_ft112AE,.-_2_gtW--Sf-Qrllj;-al-_dx.& ._QA1.----$n d...b9Q)KUB&.u1P..,.. tr�__.a�he..exia Ding aept� toAk--wi t.h.-Ralid-.-line----------------------------•------------ ----- --- ----------------- ---- --- -------- ------------------------------------------------------------------------------------------------------------- -------------------------------------------•----------•---------------------------•---------.................. I 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 rules and regulations of the San Joaquin Local Health District. (Signed)------------------------------------De Delta ------------------------------------------(Owner and/or Contraet� By:....................F—erry--- SX'#� ------------------------------------------------------� (Title) Mhz'' (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- DATE ----------------------------------- REVIEWED BY --- - DATE. :-'!...V.:---------................................... BUILDINGPERMIT ISSUED...............................---•----- ....................................... DATE-- . ----•--------............................. Alterations and/or recommendations:--------------------------------------•------------------------------------------------------------------------------------•----------•-- --•--- --------------•---...-------------•----------------------•----------------------------•---------.._..--------------------------------------•-----------•---------...--------------•--------•-------•-•-•------------. •------•-•-------------•-------•-----------•-----------------------------------•-------•--------------------------------------------------...--------------------•--------------------------------------•--------------•---- -----------------------------------------------------------••-----•--------------------•-----•-•----------------•--------•-----•-•-----•-------•-----•--•------••------..... . . .--- --•-----•- -------------- FINAL INSPECTION BY:------- --/,,I'_`''''x "--------- Date....1--Y.......--�---2� SAN=JOAQUIN 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 8-51 Revised W-2100 ; -