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APPLICATION FOR SANITATION PERMIT Permit No. 31 <br /> (Complete in Duplicate) Date Issued A-3- <br /> with County Ordinance N st f <br /> Application is hereby made to the San Joaquin Local Health D;sfricf for a permit t con luc a d n <br /> This application is made in compliance 1 0 install the work herein described. <br /> JOB ADDRESS AND LOCATION <br /> -/- - Z <br /> Owner's Name--_--_- 3------------ 14. ---------- <br /> -------------------------------- <br /> Address------- <br /> Contractor's Name_.____.___._. ......... -------- ------------ ----------------- Phone--- <br /> ----------------------------------- -------------__---------- <br /> -------------------------- ------------------ <br /> Installation will serve: Residence parfmen ----------- -------------------------------- Phone,e-/ <br /> Number of living units: _ f House E] Commercial 0 Trailer Court 0 ---- <br /> /---- Number of bedrooms Motel El Other L3 <br /> Wafer Supply: Public system []- -4dem,-Number of baths q---- Lot size .....jptr �A 710 , i <br /> 'I to a depth of 3 fee+: Sand ED ��Depfh to Water Table ------ <br /> Character of so, Community system 0 Private ------- <br /> 6ravel [] SandyLoamo ClayLoamo ClayE] Adobe 4—Hardpan E] <br /> Previous Application Made: YesO No [4��_�wConsfruction. YesED NO <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 14.— <br /> (No septic tank or cesspool POrmiffed if Public sewer is available within 200 feet.) <br /> Septic Tank- Distance from nearest well <br /> No. Of compartments -----------------Distance from ------Material <br /> _1�6 -------------------------- ---- foundation------------- "_--- <br /> Size----posal Field: D;sfance from nearest well----- -----------------------Liquid depth---------------- .........Capacity ----------- <br /> -T lines -------- -------- <br /> EA. Number o k-----Disfance from foundafion-----A-0--------Distance to nearest lot line----- <br /> �r------ Length of each line ------ <br /> F filter rnaf,rjaJ_j* 4.4---------------Width of french. <br /> Type OT W--" Depth of filter material 0------------------ <br /> Seepage Pit: Distance to nearest well_.____--_-"-""_."_. .....J /-t?---------Total length---- <br /> El Number of pits._..___""_" --Distance from foundation------- --------Distance to near <br /> -----------Lining material------ ----- ---- --- <br /> Size, Diameter nearest lot line_______________Distance from nearest well.____"* -------------- Depth...... ---------- --------- <br /> El S iZe: Diameter----------------" -----------Distance from foundation----- - ------------Lining rnaferia)_ ----- ...... <br /> Privy: Distance from nearest well___.--_"_"-------------------Depth--.---- ------------------------------------------- Liquid Capacity ---------------------------------- <br /> ................. ............................ <br /> -------- ......... from nearest building--- ---- "-----___gals. <br /> Fl Distance to nearest lot line Distance gals. <br /> Remodeling and/or repairing (describe)-------------------------- ------------------------ ---------------------------------------------------- <br /> ------------------------------------ <br /> ------------- ---------------- ----------------------- <br /> ------------------------------- ------------ ----------------------------------------------- ------ ------------------------------------------------------ <br /> ­­- ---------------------------------- ------------------------------------------------ <br /> -------------- ----------------------------------------------------------------------------------------------------------------- ------------------------------------------- <br /> ----------------------- -------------------- --------------------------------- ----------------------------------- ----------I------------ <br /> - - ----- -- - - ----- ----- ------ - - -------- - ---------- ------ ----- ------ - - - - - -- ----- ---- - <br /> ordinances,I hereby certify that I have prepared Phis appjjcafi_o_nan_dfh_a`f_-the--work-will---be San--Joaquin- - -- - --County- - <br /> State laws, and rules and re ulations of the 'San Joaquin Local Health 'District. <br /> s 0 <br /> {Signed---------- 1000 <br /> - ------------ <br /> ----------------------------------------------------------- <br /> ------ --------------------- <br /> By. 0- i-&------- (Owner and/or Contractor) <br /> (Plot plan, showing size of I - ---------- ----------- ----------- • ----------(Title) <br /> in relation to we ------------------------------- <br /> se <br /> --- ------- --------- <br /> of. location of system ---------------- -- -------------------- <br /> lls, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> REVIEAPPLICATION ACCEPTED BY------- --------------------------------- DATE_-- ----- <br /> WED BY----------------------------------------------------------- ------------------ Ad--- <br /> ------- DATE - -- ------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------ DATE-- <br /> Alterations and/or ---------- ------------------------- ------------------------ <br /> f1copmendafions: _,A1 ---------------------- DATE......... <br /> --------------------- -------- J <br /> ----- ---- -e <br />------------------- <br /> --------------------- <br /> y X ------ --- - -------- <br /> _j <br /> -AV <br /> -------------------------------------- <br /> G fin_ <br /> ---------- Pr ---------- ------- <br /> - ---------- <br /> ---------- --------------- <br />--------------- -------------------------- ------------------- ---------------------------------:---------- <br />----------------- --------------------- -------------- - -------------------------- - -------------------------------------- --- -------- <br /> ----------------------1---------- -------------------------- ----- -------------------------- <br /> ------ -- ---- <br /> FINAL INSPECTION BY:."-"- ------------------ -----------""-•-- <br /> ----------------------- <br /> a to <br /> ---------------- <br /> Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wolf Oak Street <br /> Stockton, California 132 Sycamore Street 814 North "C" <br /> ES-9-2M 10-52 Revised W-2100 Lodi, California Manteca, California Street <br /> Tracy. California <br />