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y APPLICATION FOR SANITATION PERMIT Permit No. .3- .-/ - [Complete in Duplicate] pate Issued a-=s f-y"i e Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfa11 the wor eereip desoc�l fid. This application is made in compliance with County Ordinance No. S44. $-701 Rt, 2 Box 550, Stockton; New St. Francis Motel, Hi Way 99 a JOB ADDRESS AND LOCATION----------------`".- - - - - ---------------- Mr. & Mrs. . J. Gooder 2--6226 Owner's Name-------------------•----------------- -- ------------�----...---'---------------. . ----------------------------------------- ------ Phone-- - -•---------------------- SaMe. . Next to State Hi Way Patrol Office. Address. - ------ ------- -- --- PI,P-RISH INC--r -------------------------------------- Phone----•gp ---07------------ Contractor's Name-------------•-------------- -----------------------------------------•---------• ---------- - --- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel IA Other ❑ # Number of living units: -�___-_ Number of bedrooms --'__.. Number of baths ---__ Lot size ---------------C 'CS __.------ Wafer Supply: Public system ❑ Community system ❑ Private Tom' Depth to Water Table�5--- ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe + Hardpan ❑ Previous Application Made: Yes ❑ No q New Construction: Yes ] No ❑ Supplement to existing System TYPE OF INSTALLATION AND SPECIFICATIONS: `No septic tank or cesspool permitted if public sewer is available within 200 feet.} Septic Tank: Distance from nearest well__10. t----DistarD f om found _l ation- 0 t.........Material---CC Brick�'�:D X 2�� 26t�0---Galg� ( No. of compartments --- 1 Size +r Liquid depth__�a ----------------Capacity------ ------ ------- LJ� dee �� 3 ;- --- �5T la Disposal Field: Distance from nearest welL___._._.____.._bistance from foundaf. I_________________Distance to nearest l&line_ __________. Number of lines_______________ __ _ Length of each line____7_____ - Width of trench._ t____.__-____._______---_- O xC �s 1f3 Type of filter materiaL___�'�___--_`__-____Depth of filter material__ ___ _______Total length___________________-------------i-_--- T t Seepage Pit: Distance to nearestwell150.___-____Dlstanr,•�Cf rtarnriocgdation___________________�i�+��nce to nearest 12t i fe----_._________- Number of pits Lining materia-+ ------ --�---- KSize: Diameter Depth ` ' Cesspool: Distance from nearest well-----------------Distance from foundation___________________Lining material------------------------------------- NA❑ Size: Diameter------- ------------- ----- Depth---------------------------------------------------Liquid Capacity_--------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----- . Distance to nearest lot line--------------------------------- -------------------------------------------------------------------- * System to serve addition to present units. Remode- n rl�repairin describe --------- --------------- ----- - --- -•--------_...----------------------- ------ -------- ----------------- ------------------•-------• E sting Sys tem sc ving present---unit, 4 -------------------------------------------------------------------------------------------------------•----- --------•--•------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- ------------ - %43----------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County �• ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. PAT�P.:�SH INC. {Title}___Estimator P on+ractorl Si ned ,f ------------------ By: ------------- --_-------------•-- --- f . - - -------- = (Plot plan, showing size of lot, Iota w of system in relation to wellsf uildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --------- - -------------- -------------------------------------------------------------- DATE_--------- REVIEWEDBY ------ DATE--------------------------------------------------- BUILDING PERMIT ISSUED-------------- ---------------- ----------------- DATE---------Qin ------- -------------------------------------------- Alterations ---------------------------------- Alterationsand/or recommendations---- ------------------------------ ------------------------------------------••------------------------------------------••------------------------- FINAL INSPECTION BY:_" --•---1 --------- -------------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1:30 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES—.4--2M 10-52 Revised W-2100