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APPLICATION FOR SANITATION PERMIT Permit No. __ � _�-�- v� _N Com lete in Du licate { p Duplicate) } Date Issued ._` �Iq----- Application is hereby m e to the San Joaquin Local Health District fol- a permit to construct and install the work herein described. Thisa?plicatiQn is made i co,,{{n9fiance with County Ordinance No. 549. Cis �` ✓J': t s ]1=8 and Road JOB ADDRESS AND L CATION --- --------------- Owner's Name--Jibhns-Manville Prod cts Corp. of California H�0 1}�7�Z11.----------. -- -- Phone----- -- -- Address-_---Poi _-x_1587 Stockton California ; - ------------------- ------------------ --- T R. McDONAID Sewer & Septic Tank Contractor Phone.LA 3-808? Contractor's Name—J520--El• -Paso----Mad,"sto;--California i Installation will server•' Residence ❑ Apartment House ❑ Commercial F] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of.bedrooms -------- Number.of baths -------- Lot sizeapPr_0X*160-acres---------------------- ; 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 j] Adobe ❑ Hardpan ❑ Previous Applicafion.Made:Yes.❑—No;®,�New,Construct-io.;�L:�YeslM-Flo-❑-`-FHA/VA�.-YesT4. ❑ TYPE OF OF INSTALLATION AND SPECIFICATIONS: (No septic,•.tank or'cesspool permitted if public sewer is available within 200 feet.) P r 4Septic Tank: Distance from nearest well_65P._t_Distance from foundation-U--ft--._-.Material-Reeaforced-cc—merete. ... bd _ No. of compartments--------2:---------------Size-_171x6!x71--------Liquid depth--- --ft-----------Capacity3QQQ_-9A10- Disposal Field: Distance from nearestll-_600_.ft Distance from foundat��__�1--ft-__Distance to nearest lot line-3-70—ft- Number of IInes-----------------------------------Length of each line-----------------------------.Width of trench-----------------------------_----- Type of filter materiall "" ins-pepth of filter material-----Z--ft_-metal length----u00_f°te------------------\{ Seepage Pit: + Distance to nearest well---------------------Distance from foundation--------------------Distance to nearest lot line-------- ---_.- (� ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------- ---------Dept h-----------_-..------------------ Cesspool:. Distance from nearest wel€_________________Distance from foundation--------------.----.Lining material------.---- -----------------__-----. Lry ❑ Size: Diameter-------------------------------------Depth---------------------------------- ----------------Liquid Capacity----------------------------gals. Privy; Distance from nearest well--------------------------------------------------Distance from nearest building------.__-.-_--------------------------.-. Distance to nearest lot line.-..------- zRemodeling and/or repairing describe :--- - ---�_%01E 47pS --------------------------------- f . _ r ,Ia k tite bed aaccavated txo 2:-------� --be�ond_>I3nd a1on--each--exteri� 3leach line in the leach �F field •• '; ------- --------------------------------------------------------------------------------- ---------------------I------------------------------------------------------------------------------------------------------------------------:---------- :------------------------------_._�------ + .�-1=hereby certify fhat.l-have prepared-Aii-application an'd•thaf Tre work will be doneln accordance with San Joaquin County y ordinances, State laws, and rules and regulations of the San Joaquin Locai Health District. � _________________ Owner and/or Contractor (Signed) --------------------------- ---------------{ / ) ---------------x'`--------- -=--------=----" ----- -------- r= ------------(Title)---------------------------- (Plot ---=--=-----==--------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -- � EL{., •_:a� =. T.'-`-`--- -_"- DATES-: ___4,_ REVIEWEDBY--------------------------------------------- --------------------------------------------------------------------------- ---- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------ ---- DATE------------------------------------------------------------- Alterations and/or recommendations----------------------------------------------- ---------------------------------------- -----------------------------------------------------------•------- y- ---- 5` --------------- ------------------------------------------------------- -- ------ - -------------------------------- --------------------------------------------------------------------------------- FINAL INSPECTION-BY:-- - = ------- ------- - - ----- Date---- - -�------------------------------------- SAN JOAQUIN LO AL 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 Revised 1-57 F.P,CO.