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APPLICATION FOR � R SANITATfON AE lily �;. ��t , , it No. 3--�k ._ (Complete in Duplicate) � �Y' ;�� -- e Issued ---- -------- - Application is hereby made to the-San Joaquin Local 9 Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ,e1-r. _r T JOB ADDRESS AND LOCATION_._I______ � � r-i_._� .--- --- Owner's �. � ------�/ Owner s Name ------- -----•---•---------------•---•----••- - -- -;1- _ r Phone Address ------------------------•-•- z� ----- ----•-------------•---- -��.r/�_.�_--rte' _+ ----moi__ Contractor's Name --------------------- ----------------- = -----------------------------------------------------•-- Phone--- :_ Installation will serve: Residence IV Apartment House ❑ Commercial Number of Irvin9 its:un _ _. N [j Trailer Court ❑ Motel C] Other E]�_--- umber of bedrooms Number of baths ../__ __ Lot size _ `�AJC j D r~ Water Supply: Publics stem - Q- Y Community system ❑ Private ❑ Depth to Water Table �jo ft. 1"- Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam E] Clay Loam Previous Application Made: Yes F1 No New ❑ Clay El Adobes Hardpan ❑ w Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Ta k- Distance from nearest well__Distance from foundation_ � No. of compartments_ ` Ety< <, �Q Materi�l----- u� I ... 5ize_._l j '� Liquid d pfh_.s�`L-_.--- j2jag�;?�Number Ca aciDistance from nearest well__i+�47u��_Dis#ancArom foundation___/ _ ___.""Distance to nearest lot line-__ of lines-------- -- r -"- Length of each line-_,0V_ "' r-- - r Type of filter material___ _A --_--- g - ------------------Width of trench------;-Y_ __--_--_-_--j )_j___Depth of filter material----l_.t�°'_-_---Total length ge Pit.. — Distance to nearest well_.__ g --f----------------------Distance fr foundation___, __ Distance to nearest ne___�-, • Number of pits._.._-" � � '"`"---`___-____Lini ng material__ ------Size: Diameter____Cess oaf: w3.-----"----Depth __ ___________A Distance from nearest,well___-________-_Distance from foundation_________________ _i Lining material -- Size: Diameter----- ------ ------ ----- ----Depth------------------•----- - - - -- -----o q 9--- Y Privy: Distance from nearest yell______.______________ _ �"i uia acit -----------------------•----_____._-Distance from nearest buildin❑ Distance to nearest'lot line - Remodeling and/or repairing (describe)______________ ------------------------------------p----------------------------------- I hereby if that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, tate a and rules nd regulations of the San Joaquin Local Health District. f M (Signed)---------- - =~ - ------------------------------------------------- r Contractor) By:------------------------ (Title)- ---- ---• - ----- (Plot -- < - ------------ ---- plan, showing size of lot. location of system in r +ion to wells, bui Ings, etc., can be pl ced on reverse side). ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-_______- "-"------------ -- ------------------------------------------------------- DATE--------- REVIEWED BY-------•------------------- ----- - - _ - - _ ------------ -- - --------------- - -- BUILDING PERMIT ISSUED-------------- ------------------------------------------------------------- --- DATE ------------------•--------------- --------------- DATE------------------------------------------------------------- --and/or recommendations------------------------- -------------------------- --------•------------•---------- --------- ------------------------------------ ------------------ ---------------------------------------------------------- FINAL INSPECTION BY: _.__ --- 2 -- - --- - ---------------------------- Date - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street132 SI ycamore Street B!4 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100 a