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t , t s APPLICATION FOR SANITATION PERMIT Permit No. 3.1. -__3 �/14V, \ AVe (Complete in Duplicate) _ { `� /If Date Issued c�Applicatio�� serebyanJoaquin Local Health District fora it to con "this app ion is made in compliance with Count Ordinance o. 549 p construct and install the work herein described. ,. Y a JOB ADDRESS AND LOCATION___1 -- ----- ------ Owner's Name - -- ----- = --------------------------- Phone J Address ` --- ----..--- -- -•-- ----------------------------- Contractor's --------•---------------- Contractor's Names ` 1 �., 1 _ . - Phone_ Installation will serve: Residence I A "tment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other 1771 Number of living units: .___ umber of bedrooms ________ Number of baths � ,/---- Lot size Water Supply: Public system Communify system El Private E] Depth to Water Table4-a_ ft. ` i Character of soil to a depth of 3 feet:) Sand oe_6ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑- Adobe ardpan ❑ t 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-----------------Distance from foundation------_-_-________-Material _"-"_._____..__-_._._.__._._-".._ I No- of compartments----i----- ------- --------------------------------Liquid depth ----------------- --------Capacit y•--- �, ; ! Di pas I-Field: Distance from nearest wed)&_ f,- istance from foundati _ __ ________.Distance to nearest lot line -0 - Number of lines----- 'aGt. " --- ____Length of each line___ ..�--- Width of trench..___ Type of fitter mate iiaf �_ -- -- �_�_Depth of filter material---/_�__.._-,-----Total length------------- Q.------------- - -k. eepage Pit: Distance to nearest well----------------------Distance from foundation_______.........•...Distance to nearest lot line________________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----•------------ ----.Depth------------- ------ Cesspool: Distance from nearest well-----------------Distance from foundation_------4________ Lining material--- ❑ Size:_Diameter---------------------------------= ---Depth------------------- ----- -- -------Liquid Capacity------=--'- Privy: Distance from nearest well________ _________________________Distance from nearest building ❑ Distance to nearest lot line-------- ` w. -------- - --------------- - r Remodeling and/or repairing (describe):------------- ._ ._______ ---- -•-•---- •---- ----------------------- ---------------------- - sr^�' ---- -----•------_--.-- 11 ----------------------------------- ----------------------_- -----------:---------------------------------------------------------------------- ---------- I hereby certify that I have prepared this application and'thaf the work will be done in accordance with San Joaquin County ordinances, State lows, and rules and 'regulations of the San Joaquin Local Healt District. (Signed) !111 e�ll Z ' (Ow - anor ntrac#or) BY: °rAw {Title} (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." ------------------------------------------------------ ---- :- --- ----------------------------------------------------- -- --------------------------- EVIEWED BY ---- ------- --- ------------------------------------------------------------------------------- DATE--- BUILDING PERMIT ISSUED= DATE----- QS\ Alterations and/or recommendations:__---------------- ��------------------------ --------------------- ------------ -- --- ----- i ----------------------•-- --•---------- l_?- --- ----- f"-`"�`7 r ff - -- rvee - =k ----- -------------------------------------------------------- (` ------------------------ ------------------------------------- ------ --------- ------ - -------------- --------J---------------- ------------- FINAL INSPECTION BY:. --- --/- -- ----�-------•----- 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