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APPLICATION POR-SANITATION PERMIT Permit No. <br /> 3 <br /> (Complete in Duplicate) <br /> Date Issued <br /> Application <br /> Is heremade to the San Joaquin Local Health District fora ermit to con <br /> struct and install the work herein described. <br /> 'sapplication is ade in compliance with County Ordinance No. 549. p <br /> JOB ADDRESS-AND LOCATION'...---- ----------rd-kyl— —----------------------------------------------------------------------------- <br /> ------------------ ---------------------------------------------- Phone <br /> Owner's Name--------------------------P <br /> Address <br /> Contractor's Name--------------------------O.-ZA[1!1 <br /> P-------------------------------------------------------------------------------- ---------------- hone <br /> Installation will serve: ' Residence �Ap,.rfment House [-] Commercial El Trailer Court El Motel E] Other El <br /> Number of living units: /---- Number of bedrooms ,umber of baths __1--- Lot size ------------------------------------------------------------- <br /> Water Supply: Public system El Community system E] Private [-I Depth to Wafer Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loom Ej Clay Loam E] Clay ❑ Adobe g,-f4_a'rdpan E] <br /> Previous Application Made..- Yes E] No New <br /> Construction: Yes R- , E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic farik or,' .cesspool permitted if public sewer is available within 200 feet.). <br /> Septic Tank: Distance from nearesi well---IV"tDistance from foundation -------Mate/,i aI__ _ <br /> ...... ............. <br /> .......... <br /> No, of compartments------ --—-----------Size__7_��4�k/,_OX-41_iquicl depfh----------0:?---------Capacity----- <br /> Disposal Fie�cl: Distance from 'nearest well__4j4_W,-C_.jDisf6nce from foundation----/V_*.._.Distance to nearest lo't line __,f7 <br /> CE Number of lines--- ----------- --- ---------Length of each I�ne__710---3 0------..Widfk of french---------��74 <br /> _2 <br /> Type of filter material;57�,1,.--P,,41A---�Depth of filter mafer'al------/ <br /> ----- ---Total length------------/6&9-- <br /> Seepage Pit: Distance to nearest welt.._________________- <br /> --Distance from foundation----------_-- .... Distance to nearest lot line <br /> Number of pits----------------------Lining material------ -- -------------Size: Diameter-----------------------Depth----- --------------------------- <br /> Cesspool: Distance from nearest w6ll-----------------Distance from'foundation------------------- Lining material-..____---_.__.-___.___--_ 1 7 <br /> EJSize. Diameter----------------------- ---------------Depth------------------ ------ ------------ I <br /> ---------------------------------- Liquid Capacity------------- - --------gal'. <br /> r - ----------gals. <br /> Rrivy­,�- ;Distance from-rcares4t well"--' <br /> ------- -------------------------------- --- stance frorn­nea� est uilding---------------------- <br /> -1, - _D�' r -------- <br /> F- Distance to nearest lirre".:—------------_.— — -. --------- <br /> --------------------------------------------------- ---------------------------------------------------------------------- <br /> R4modeling and/or repairing �clescribe):------------7 <br /> - --------- <br /> ---------- <br /> --- ----------- ---- ------------ ---------- <br /> ---------- ----------------- --ft- --- ----- A <br /> ------- -PAA-4 I - ----- <br /> V <br /> - <br /> -------------------- .. .... ------------ <br /> ------------- <br /> __j----IWA-_ <br /> --------------------------- ------- --------------- <br /> ----------------------------I-------------------- ---------------------------------------------- ---------- --- <br /> I hereby certify that I have prep r this application and fh6if the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and 'regulations of the San Joaquin Local Health District. <br /> (Signed) ' -----------------------------------I-------------------------------------------(Owner and/or C onfractor) <br /> By:-----------------------------------------------------------------------------------------------------------------------------------_ATifle)------ --------------------- <br /> ,(Plot plan, showing size of lot, location of system in 'relation to wells, buildings, etc., can be placed on reverse--side].- -----------FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> REVIEWED BY ----- ---- .DATE - -- --------—---—------------- <br /> --------=--------------------------- --- -- <br /> BUILDING PERMIT ISSUED ----- -------- --------------- ------------------------------------------ DATE-'- <br /> Alterations and/or:recom3w6dations:--- - ------ - ----------- -------------------------------- <br /> ! ------------ ---- -- -------------- ----------4- <br /> ------------------------------------- <br /> ------------------------------1. - ___ i <br /> ------ --- -------------------------- <br /> ------------------------------- <br /> % - %--�------ ------------- <br /> ----------------------------- ---------- --------------- -—----------------- ---------- ------------------------------ - ------------- <br /> -------------------- -------------- -------- ----------------5p�__3......- - ------------ ------------------ <br /> ---------------------------------------------- <br /> ------------------------------------------------------------------- ---- ------- <br /> --------­------- <br /> ----- --------------;---------------------------------------------------------------------- <br /> 1.a:1 <br /> FINAL INSPECTION BY:------------0 <br /> ----------> Date------------ Jop -- ---- <br /> ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />