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01 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) n. Date Issued Applica}ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made m compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------------GA/---- BG G-1{------- �c�'-�` ------------=------------ � - - ------------------ Phone Owner's Name___________ Address.. tl --- ``=_"�`"' ------------ -- --- Contractor's Name__.- _._ le--- --- -----------------------------------------•-- Phone- _ < Installation will serve: Residence Apartment House ❑ Commercial [3Trailer Court ❑ Motel ❑ Other [I Number of living units: I__- Number of bedrooms __��„-- Number of baths 1_f_Lot size _______ ------------------------------ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table,, ft. Character of soil to a depth of 3 feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay;Loam ElClay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ NoQ. New Construction: Yes Ly—No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank:or cesspool permitted if puW sewer is available within 200 feet.) R Septic Tank: Distance from nearest well_ / Distance from foundation__ /4..___.____.Material_.__(f- •r '�1��------ No. of compartments---- - --------------Size__. --- - --Liquid depth-----&.0_.----------Capacity _..-------------_----- � j .Jr Distance from foundation___47--_-----Distance to nearest lot line----,--.- Length ine____, Disposal Field: Distance from nearest well_�______ ._-. � r r ; Number of lines_________. --- Length of each line_______ . ---.-f{----Width of trench._____ S� ---------------- �z ------ _total length Type of filter material._l4___-__.�rt[Depth of filter material------- g r Seepage Pit: Distance to nearest weILQ____:Distance from foundation____ .__..Distance to nearest lot line________________ Number of pits-_ - --------------Lining material__' . Diameter_._ ��-- ----.Depth_-._ �------------ Cesssppool: Distance from nearest well_________________Distance from foundation--------- ----------Lining material-----------------------._--___.______. ❑ -Depth----------------------------- ----------------------Liquid Capacity----------------------------gals. Q Size: Diameter------------ ---------- ---------- Privy: Distance from nearest well------------------------------- Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------------------------- ----------------------------- -------- `1} Remodeling and/or repairing (describer------=----------- ---- 4-- ----------•--- -•------------------------------------_--- ------------------------------------------------------------- • -- l\ � . ---------------------------------------------------- --------------------------------�_:-------------------------------•----------------------------------- I. ------•-•--------------------I.hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, a d rules and regulations of the San Joaquin Local Health-District. [Signe ------- •-----�-•-�--- ------ By: {O wner and/or Contractor) ------ ----- yTitle ------------------- --- (Plot plan, showing size of-lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ti FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- -------- -- ---- ------------------------------------------------- DATE. _ ;- �"' liioW REVIE DATE------------ ------------- •---------------- EDBY.-•--------------------------------------------------- ---------------- ----------------- ---------------------- BUILDING PERMIT ISSUED-------------------------------- ----------------------------------------- ------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations-------------------------- ---------------------------------------------------- 1 ----------- ------- =: ------ -- ---------- --- ---------------------------------------- - - ------------------------------------------------------- 3--- � `�5 ----------------------------- FINAL INSPECTION BY: --- ---------- •------------------- Date---------------•------ SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street $14 North "C" Street 130 South American Street 3a0 West Oak Street y Trac California Stockton, California Lodi, California Manteca, California Y. .. o ..:_..a w_Iinn