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\\ 1PUATION FOR SANITATION PERMIT Permit No. _ _____ - �u 42 + (Complete in Duplicate) Date Issued _ ------- gplication is hereby made to the San�paquin Local Hh District for ermioconstruct` s application is made in complian a with County Ordinance No. 549, permit d� stall the work h rein de�li�ed. sw JOB ADDRESS AND LOCATION______________ k --- - /---------- GCS f -� Owners Name 2-5 -"4---•-.0 -:---------:.7 Phone Address---------------_------ .... `l _ - ------C--f� -------------------------- Contractor's --C,--- - ----------------------- ---------------------- Contractor's Name----#-----------------------•--------�-------- _ `"} <� : ----------------••--------------••-•- , ------------------------------- ----------•-------= -----------------------------•----- > _ _ Phone------•---------------•----------- � Installation.will server Residence Apartment House ❑ Commercial b—Trai[er—Court-'[I' Motel,E] Other 0 ' l Number of living units: ---�—Numbe'r of bedrooms __ . Number of baths ___y"Lot size --------- ,,, Water Supply: Public system " Comm ity sysfem 01 Private ❑ Depth to Water Table':_'z ft. Character of soil to a;depth of 3 feet: Sand ❑ Gravel❑ Sandy Loam°ClaY Loam ❑ Cla y ❑ fldobeL�' Hardpan ❑ � .. Previous Application Made: Yes ❑ No �`New Construction: Yes No i �- TYPE OF INSTALLATION AND'SPEC IFfCATIONS: ..4 (No septic tank or cesspoof permitted if public sewer s available within 200 feet.)I 1 Septic Tank: Distance from nearest well _____________---IDistance from foundation-_-_:�U____ ---.Ma - ---. ------------------- NO.' t na _ o compartments Size x J K-"aFIquid depth----- +� i' ` Capacity Di os Field: Distance from nearest weld~ -_---,_;Distance from foundation__�:_1-__-:------Distance to nearest lot line----4_-------- NumUer of lines----------3-_:_�_`. __ _-.___ILength of each line----'�,�,��5�._�Width of trench-._._-__--2-`�_�`'.._- ___ Type of filter materia!_ pT r` FDepth of filter material._-_.__/ �' Total length -_ U--"' CJO !! I Seepage Pit: Distance to nearest well_________________-___D.istance'from*foundation------- -----------Distance to nearest lot line_____._ r ❑ dumber of pits. ----------'----Lining mate ial--------- } SizeameterDe to -�--f p ---- Cesspool: Distance from nearest well________________ ; ` { Distance:f+om foundation________________ __Lining material------------ _.D Size: Diameter--------------------- ----------------Dept------- J:� ----- ----------------- ! 7' � F Liquid Capacity gats. Privy: Distance from nearest well__________________�_,_-- F _-.____--.._Distance from nearest building : �A 9 ❑ Distance to nearest lot I'ne_________________�__�_..___- V7_ -------•------------- ___ Remodeling and/or repairing fdescribe):--------------------------------------------------------------- ---------------------- T -------- -- ------------------ --- ---- -------------•• ----------------------III----------------•------------------------kL--------------•----------------------•=---------------------------------------- - ----- --- --- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------- I'hereb certify'. ertif 'that I have p pp Y y pre ared this a lication and that the work will be !done in accordance with San Joaquin t ordinances, State laws, and rules and regulafions of the San Joaquin Local Health District. County (Signed)*s --,n I j I -- I / ------------ - ---------------- Owner and/or Contractor) - ------------------------------------ By:- ' _.. -_.._.�.---- - ----- -_x--- -- ------------- •-----------•-----------------------(Title)---------- ------------A ----------.................... ....... + (Piot plasize of lot, location of system in relafiiol to wells, buildings, etc., can be placed on reverse side). S "I FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED�BY ____ _ �,.. ,_ w ��,,- DATE__ / >----- ----------------- -REVIEWED BY------------=--------- ---------- ----- -------------------- ; BUfLDING PERMIT ISSUED-------------•-----------__--- ------ ----------------------------------------- ----- DATE --- ---------------------------------------------••----------------------- DATE----------------------;.------ ------------------------------ Altefa$ions and/or recom dations:_-- ► - -,.�.- (J _' _.�: . -- ------ ------- - --------- - - - ------- te* - -, - --- -- - ----- - - - ---- - --- --� ---- -- --- �j s+�y' ____.......... __ "'"' .._. e� -_ _ /-- c._.a _cif' - ldi�} • f __f ___________________________________________•_ -_-._ FINAL INSPECTION By,-.,w _______"'__._�'______-__-�"�'�-G•�.,,�-_____-_ Date-------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 Soufh American Street 300 Wesf Oak Street132 Sycamore y Streef 814 North "C" Streef Stockfon, California Lodi, California Manteca, California Tracy, California e f ES-9-21A 10-52 Ravised W=2-1.00