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APPLICATION FOR SANITATION PERMIT Permit N6- ._. .............. � (Complete in Duplicate) Date Issued__ �+A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. �P � This application is made in compliance with County Ord' ante No. S49.� r%h /� ---------- JOB ADDRESS AND LOCATION-_/(--- -- / --- ••---------------------- -------- ----------------------•------------ /;� --------- ------------------- --- - Phone--- ~�__�-�` ----•--- Owner's Name-------s/� �% Gam/ � -•--------------------- - Address----- . ------- /4 Contractor's Name----- - ------- - - - -- --- Phone_? ---fo- ---f'------ Installation will serve: Residence Vf Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-cz2' Number of bedrooms __ Number of baths _� Lot size ___1!-• ----X--5— -.1 - ------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 3.f ft. 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ( Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yesx(No ❑ TYPE OF INSTALLATION AND SPECI (CATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)/ P Septic Tank: Distance from nearest well________.---..__Distance from foundation__-_.4_:___-__.Ma erl�l___- __Li u�d de `til--___ . 0- No. of compartments........:.. ...........Size_''_/X,//A--=-•- G P.' Distance from foundation__. .- --___:._.Distance to nearest lot lin t_ Disposal Field: Distance from nearest well _____________ , // Number of lines-----------• -------- -----Length of each line--- la-�------f-----.Width of trench------- _ --------------------- - ------------ ----,� I Type of filter material ._'. .--Depth of filter matenal____ __ _ ....... otal kength______ Q: ---- 4t ¢` - Distance to nearest lot line__-Jr_______ Seepa a Pit: Distance to nearest well__'________________Distan��j from fo ndation____c _ __._ _.-_. Number of pits--------- ----- --Lining material .--.Size: Diameter,;.._�_�----- ----.Depth------�_!�,11 Cesspool: Distance from nearest well______________-_Distance from foundation_.--________.___--..Lining material__..__-__--------___---.._.________ ❑ Depth ----------------------------- Liquid Capacity gals. Size: Diameter---------------------- ---- p Distance from nearest building Privy: Distance from nearest vaell---------- ------------------------------------- g------ -------------------------- ------- ❑ Distance to nearest lot line-------------- - --------------------------------------- ------------------ r:= Remodeling and/or repairing'describe):____- - - -- --- •----------- ------- ----- --------- ----------------------•----------------------------•---- 4' � ---- •--- ------------- ----- -------------••---------------•--------------------------------------------------- -------------- 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. an r on act Si ned ----�Onerand/or tr os By: --------------- ---------------------------------------(Title) Y• G��== (Plot plan, showing size of lot, location of system in ration to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE. -F *j r --------- REVIEWEDBY------------------------- - DATE----------------------------------------------------------- BUILDING PERMIT ISSUED---------------------------- DATE ' Alterations and/or recommendations ----- -----------------------------•---------..------•- ------------------------ -------------------------- ------------------------------T'-----------' ------------------------------•------------------------------- ---------------------------------------------- - - i FINAL INSPECTION BY:.----------------- --------- Date ----- -------- ---------------- -----------------------•---- SAN JDAQUIN LOCAL HEALTH DISTRICT l 130 South American Street 300 West Oak Street 132 Sycamore Street 8!4 TracNory. "C" Street Tracy, Stockton, California Lodi, California Manteca, California California ES-9-21A �o-52 Revised W-2100