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APPLICATION FOR SANITATION PERMITPermit No. 3______ (Complete in Duplicate) �U y jy ` Date Issued Application is hereby made to the San'Joaquin Local Health-District for permit to construct and install the wort; herein described. This application is made in compliance:with County Ordinance No. 549. JOB ADDRESS AND`L ATION -- ---- -!-"L _ -- - ----------------------- �• Owner s Name------ ==--- -- `-_- --- _ '' hone ; . ---•---------------•-------- -------------- Contractor's --•------- •-Contractor's Name'-A.." --- =`— -------------------------------- ------------- Phon ----------------------- ---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ....--,Number of bedrooms __ Number of baths ___�_-. Lot size __ __.�_'_ ___ _ __i ______________ _ Water Supply: Public system ❑" Community system'❑ Piivate ❑ Depth Water Table ______ ft. Character of soil to'adep+h of 3 feet:, Sand Gravel ❑ Sandy Loam [Clay Loam ❑ Clay D Adobe ❑ Hardpan ❑ L Previous Application Madec Yes ❑ No New Construction: Yes No ❑ FHA/VA: .Yes ❑ No ❑ - t i TYPE OF INSTALLATION AND SPE ClFICATI NS: (No septic tank or'cesspool permitted if public sewer.is available within 200 feet) i Y Septic Tank: .DIstance from nearest well____7`77!-Distance,from=foundation:___: Ma ia ._.._ No. of compartments----- _ ze_ -A' -__Liquid depth_ _ _____---`__-CapacityB� -, Disposal Field: Distance from nearest well_----~__`.Distance from foundation---/r-___.____.Distance to•nearest lot line._-__� ___ Number of lines_----°: -----'--- -._ -_ !.Length of each line--- ---2-L -----------Width of trench----- -�'`-_------------- 4! r Type of filter material Depth of filter material' _I.�__________Total length___ ___ Q:__..__-___ p g co of its___. m_foundation �(,..--.:._____.Distance to nearest lot line___ ------------- umber _.____..__ r. � See a e°Pit: Distance to nearest wall,' ____Distance fro m p f Lining materiaL_�� ize: Diametr__ _"J___..___ Depth__ Y_^.____ Cesspool: Distance from nearest well _ ______,-_Distance from f undation___._-------------"_____.Lining material------------------------------------ F1 ___________ ___ _____ _________❑ - Size: Diamete ------------------I---,-- t .Depth------------------------------------------------ Liquid Capacity -_ ` gals. ` _ Privy. Distance from nearest _ .._._.___ -------------Distance from nearest building_:_ ______ _______ _ ❑ 4�-. - Distance to nearest'Iot line" - "'. ,�-_._r.w�_. ,. ------ ------ -------------- --- Remodeling. and' repairing (describe):---_-- '-------- -- ------------- . t --------•--"--------------------------------- ------------------------ - ----------- -------------------------•----------- . i## «�• �: ---- --------------------------------•--------- --------=--------------------------'-----------------------•--------•-----....--------------------------------------------------------------------------- ----- - . 1 ` ------------------------------- -------t----------------- ---------- ------------------------------------------------------------------•-- --------------------------------------- I hereby.certify that ],have•prepared this application and-that the work will be done{in accordance!with,San Joaquin County ardinance5, State laws, and rules and®re s of the San Joaquin Local Health District.Si ned ' _'' 4�-Rvr �-•.- -- ------ ---------- [Oywner and/or Contractor) (Signed) GB --------------------------- T'+le ------- --------------------------- (Plot -- ----- ----- (Plot plan, showing_size of lot, location of sysfem in relation to wells, buildings, etc., can be plactdP' reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- ' DATE ---------------------------------------------------'x , ! r r REVIEWED BY-----I-- D`ATEn BUILDING PERMIT�ISSUED___ --------- _ 1- - DATE Alterations and/or recommendations:-_4 ---------9-------`---------------------------•------------------------------------••--------------i---------•---•-•---------------------------- ----- .---------------•--------------•---------•-------------- ----- ` - --- - � - - _ -- _ • ------------ 7 FINAL-INSPECTION -BY::� -----------'- - --.'-- --_ Date--�. - 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 Revisea 1-57 F.P.CO.