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I APPLICATION FOR SANITATION PERMIT - Permit No. _Z -3-3... _ (Complefe in Duplicate) Date Issued lth District for a permit to construct and instal!the work herein described. Application is hereby made to the San Joaquin Local Hea This application is made in compliance with County Ordinance No. 549.E JOB ADDRESS AND-LOCATION-f.------------------ o - I - ----------- --------------------- Owner's Name- --- Ij --------------------- ----- ------•--.----- 4 P ho .i _ _ Address----------------- ------ ----" f' rl,t, •f ,. / - Contractor's Name------------ Q1, y { � •-- %Phone-A,4- Ir i Insfallafion will serve: Residenc9 A artmenf House Commercial ler? f p ❑ ❑ rai a Court ❑ Motel ❑ Other ❑ . . , Number of living units: - _ Number of.bedroom`s 3--_ Number of bath__ Lot size 4�4� Water Supply: Public system '® Comm sn'ity sys�t�em ❑ Private ❑ Depth to`Water Table' Character of soil to a "depth of 3 feet: Sand Gravel 0 Sandy Loam ❑ Clay Loam ❑ . ClayHard" 1 l+ ❑ Adob ❑ pan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ NoL FFIA/VA TYPE OF INSTALLATION AND 5PEC[I! TIONS: d ' 4W ' (No septic tank or'cesspool permitted if public sewer is available within 200.feet.) tD tic Tank: Distancefro m nearest well_- -------------Distance from foiindation_.--:---- _---•No. of compartments--------------- sit�, Size- -------------------=•--- Liquid depth "' �`-Capacity- ----- -- -- -----isposa Field: Distance frog nearestell'! _~Den Length of f om foundafion___ - _ -___-_ s} i _T_ I l W -- - g each line.............. -.......Widfhcofttrenches �ine [�� Number fifer, eines___-____-- - --- Depth of filter materrai-----/�-______--".Total length------- , ---- ----------- (I Type of filter materiaL.s__ d -- r Number pits- �--+ Linin Distance"from fou da�t1ion--�d__--_-'__.Disance to nearestlot line--` --__f__See a e t: Distance'If to nearest well ___ p 9 g cmaterial- : —---Size: Diameter::---- _ -i %: - Depth Cesspool: Distance:from -nearest well-----.-----------Distance from foundafior-- _- --..Lining material------------ ----------- 1 ❑ Size: Diameter------ -------------- -------------------- --- --Depth-------- Li uid Capacity , # .gals. t -_ ,.� q ( p y------- - --------------- Privy: Distance from nearest well-----------------------------------------------------Distance from nearest'.building __ - ---------------------- ❑' Distance to nearest lot line__-_:-'~~o-:- .. 4 .� ' f ------ I r1%1 Remodeling and/or repairing (describe)--------------------------------- 1_------ --------------------------------^------l i-r,:r,:r�.�..�ro. ----- •. --------- ------------------------- ------------------------------------------------ - -�---• o ----------------------- ----- --•-•------ ---------------- -------- . -----•---..-----------•---------------------------------------------------------•------------------------------------,--•--- --- -------- ' --•----------- --------------- -- ----- -------- ;—:---------- --- �-= F f 1 -------- I hereby certify"that I have prepared this application and that the work will`be4done in accordance with San'Joaquin County ordinances, S-fa a laws" an rules and r ulations of the Sari Joaquin Local Health District. (Signed) _d_...,. - -- t By:------_---------- .- - - caner an or Contractor) : -- ---(Title)--.---- (Plot plan, showing size of lot, location of system ` ,relationFto wells, budding efc can be placed-on reverse side).') ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- DATE_____ __ ___________ ___ F -- REVlEWED BY ' DATE ----- - BUILDING PERMIT ISSUED--- - ----- ------- ---- ------•-----------••-------------------------- ----------------------------------- Alferationa and/or recommandations:fi______________ _ __ � � ATE---- __-- ---__-___-- . ------ ---- ------------------------------------- ------ t -------------------------------------------------------------------------------------•- : ---•-•---------------------- - -- - ----- ---------- ------ ----------------------.--- K .. ------------------------------------------- FINAL INSPECTIONBY:-- _ _-- -- :--_/-- ----_-- G # Date------- --- Q 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 Revises 1.57 FT-CO.