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------V*4�"K APPLICATION FOR SANITATION PERMIT Permit No. 3 (Complete in Duplicate) .............. Date Issued I Applicarlion 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 0 di ny r inanc N of JOB'ADDRESS AND LOCATION........ 5Z C------------------- ----- ------------------------------------- 0 - R. Owner's Name----- ......... 4 - --------- Address---------_-- .... -------- ----------_A--------------------- -------- -- Phone _---------I-------- / - 4 � A ---- ------------- ---- -------- -- ------ Contractor's Name--------_1Z) -------/ye" . ____7" -------- ------_ ------------"-- phone_ _ Installation will serve: Residence Apartment Commercial I Trailer Court [] Motel ❑ Other ❑ -Number of living units: _ Number of bedrooms __� Number of baths6i�---- Lot size .......6.-o........x (4 Water Supply: Public system ------------------ DI-C'mmunity system E] Private Ej Depth to Water Table 3-r-ft. Character of soil to a depth of 3 fee"f: Sand Gravel 0 Sandy Loam E] Clay Loam ❑E] Clay [] . I N( be 2'/Hardpan E] Previous Application Made: Yes E]: No New-Construction: Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS: ;(No0 s2 e tank or cesspool permitted if public sewer-is available within 200 feet.) tic aA_k: Distance from nearest weli-----------------Distance from foundation No. of compartments--_---__-- -"""-_-____-._._""_.Material_--""_"----------------------------------------- ---------------Size-------------------------------Liquid depth---------------------- - . __Capacity----------------------- s ield: Distance from nearest well-___----_-- Distance from foundation---------------- ---Distance to nearest lot-line------_-_"_ �Z�Number of lines--------------------------------- -Length of each line------------------- -- ----- --width of trench Type of filter material-__- Depth of Iter material--------L--------------Total length------ 16 -------------------------------- Seepag t: Distance to nearest well_.-._-"_-.4r�i)_ Distant %ormgundation---- )st n Number of pits-" in r 1------�[ ---- ----------J___Size: Diameter-- - ---- ------. Depth--- ----- -----.-L ing material-). .... �st nearest lot line Cesspool: Distance from nearest weq-----------------D;stance from foundation-"-.__.-__--" ---------------------- ❑ Size: Diameter.----------- ------ Lining material---------- ------- ---------------------'----Depth--------------------- -------------------- ....Depth----------------------------------- ------ ---------Liqu;d Capacity..... _------------ F1 Distance to nearest lot line__ --------- ._Distance from nearest building----------------------------------------------- Privy: Distance from nearest well-------------""__.-.-__"--.-""__ ---------------gals. ------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------------------ -----------------------•---------------------------------------------------------------- ---------------------- ----------------------- ---------------------------------------------I---------- ------------------------------------------------------------------------------------------- -------------- ------------------------ ------------------------------------------------------------- ------------------------ ---------------------------------- ---------------- --------------------I---------------------------------------------------- -------- ------------------------------------ ----------------------------------------------------------------------------------------------- --------------------I--------------------------11--------------------- --------- I hereby certify that-I have prepared this application and that the work will be done in accordance with San Joaguin, County ordinances, State laws, and rules and'regulefions of the S Joaqu* Lo al alth District. DAY& NIGHT'ton' the qu- Lo (Signed)- -------- 5RPfiC__Tank_5wvjge-------of--------S __J' u! {Title) --- -------- - -- -- ------------------------ -- ------j@WffVll-V1Tdhw_Confr-acfo By. ---------12U-So. Eldorado HO 2.7049 - - - r), t_ _ ---- ---------------------------- --------- ----------Stockton; ------------- ,jrn - - ---------- -- --------------------------------------- (Plot plan. showing.size of lot, location o system in rely n to wells, buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-9 I REVIEWED BY--------- ----- ------- --------------------------- ------------------------------------- ------ DATE- REVIEWED DATE-_t�-—--------------------------------------------------- Jr------------------------------------- ----- ---------- -----------------------------------------•----------I ----------------------I----------I------- -------- BUILDING PERMIT DATE------ Alterations and/or recommendations- --- ----------------------------------------------------------------*----------- DATE-------f^------------- ------------- ---- --------------- ------------------- ------------ ------------------ ----------------------- 6-- ------------- -------- ------- ... ------------------------ -------- ---------- --------------------- ----- ------ IF ---------I.r- ----------- --------- - ----------- ------------ --------------- ------------------- -------------- ------------------------- ------------- ... --------------- ----------- -------- FfNAL -INSPECTION BY:-----_-- --- - ---------- -------------------- ---------- Date----- 130 South American Street SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 146446 ATW(JUD