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APPLICATION FOR SANITATION PERMIT Permit No. ,3. (Complete in Duplicate) 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. JOB ADDRESS AND `L/OCATION...-------3--------f aX 3 ---------------------------------/V'S,� � v....' e�? .=.._'v..........Z----------- Owner's ...:Owner's Name-------5...f' ! _�.�/ 1Y'`9 T AA V S S o A/ - Phone-..y ? -- _ --------- - Address...............RL.3...-..... .e..x-....S--3----------------------------------------------------------- Contractor's Name-----------. '`� ` Phone me CT, O ........ Installation will serve: Residence Er Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other F] Number of living units: -------- Number of bedrooms -------- Number of baths ........ Lot size .--,-------------------------•-_---.,._--.._--.-_.------ Water Supply: Public system ❑ Community system ❑ Private Er Depth to Water Table _,3.7, ft. Character of soil to a depth-of 3 feet: Sand❑ Gravel ❑ Sand_ y Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q- Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes [] No ❑ 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---7--O-(__.Distance from foundation--_-_-[f7.- _.Material---5-C_ Qir "C/'(, 1 No. of compartments------. .c' -___-....Size._ur -_Xz X! __Liquid depth_-.----.9.' ___.-Capacity_--�0� A� . Disposal Field: Distance from nearest well-•(/1. .-Distance from foundation....Id......._.Distance to nearest lot line.-LQ./._..... ❑ Number of lines---------L-----------------------Length of each line-_--71------------------Width of trench _-A"1�._-._....._.__....... Type of filter material....tl/�tl1!_Z;------Depth of filter material__N!b!'_-.Total length_._----.- -.5 --- -------------------- Seepage Pit: Distance to nearest well--_10 0-.'7--------Distance from foundation____41L2__=_....Distance to nearest lot line---/2 -------- 0 Number of pits------1-------------Lining material.., Diameter__._-'�!- .._�...Depth-----._A-S.-f.............. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material..._.._---_._._..-_..__--_...•.------ 1 ❑ Size: Diameter------------------ -------------------Depth-------------------•--_----------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------.----------------------.----. ❑ Distance to nearest lot line-----------------------------------•-------•----------------------------•-`--------------:-----------------•-------------------------- Remodeling and/or repairing (describe):------------------------------------------ ................................ ------.... --••------ ...............-----••-----•-44,4'. --••-....----•-•-•--•--•-•---•----------------•--•••---------_-...-•••-•--_•••--_---••-•••-•--••-•-•--•-------•-_---•-•--••--•----•------_---•-----_-••----•---------------==---......------•---------•---•_--_-_-_--.--....-- -------•-------•-------------•------------------------------------------------------------------------------------------------------•-----------------------------------------------...........----•------------------ 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).........�'..... 3 P%5 ----------------------------------------------------------- `'� .....(Ow r and/or Contractor)\ ,� BY' �'k! ._. t _a -- ----i----- ------------- Va (Plot plan, sd�ring size of lot, location of system in relation to wells, buildings, etc., can be place on reverse side). !l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------- - - -- ------------------------------------------------------ DATE----------•} . {.. REVIEWEDBY----------- - .. ---------------------------------------------------------- DATE-----------!--2'--� �-----�'------------------- BUILDING PERMIT ISSUED ----------------------------•------ -------------------------.- DATE--------------_-------------------------------------.----- Alterations and/or recommendations:.............--------------------------------------........................................... .............................................. --------------------------------------------=----------------------------------------------------------------------------------------------------------•-----------•-•-------•-------•-----------------•--------•----•----- -------------------------------------------------------•----------------- ------•-------------------------------------------------------------------....------------------------------------------------------------------ ---------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- -------------------------------- -------------------------------•------------------------•-----------------------------------------..-.-......------------------------------------------------------- ------------------------------------------------------ FINAL INSPECTION BY:/.6-- � Date----- ------------ - --------------------------------------------- SAN -------------- -- -----------..------------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-9-2M 10-52 Revised W-2100