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APPLICATION FOR SANITATION PERMIT Permit No. -- G S (Complete in Duplicate) Date Issued 7-"- 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 in compliance with County Ordinance No JOB ADDRESS AND LOCATION-- Z46--g�-- ----- --------------------••------------ Phone----•---------------------•----•--- W-W Owner's Name-- �-, I - ------------------------------------------------ Address ---- ------------------------------- Address----------•------ --------- ---- Phone...........------------ ---------- Contractor's Name--------------------------- -- ------------------------------------•---------------------------------------Installation will serve: Residence 4 Apartment House ❑ Commercial ❑ Trailer Court ❑r Motel ❑ Other ❑ Number of living units: Number of bedrooms _ - Number of baths _ _____ Lot size --- --------- Water --------- Water Supply: Public system)J� Community system ❑ Private ❑ Depth to Water Table ______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg,,'Hardpan ❑ Previous Application Made: Yes.K No ❑ New Construction: Yesyx No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 280 feet.) � f�} ---------Material---)2_Lr L.2 ------------- Septic Tank: Distance from nearest weIlllll�_h[-�--Distance from foundation_______ Capacity _ No. of compartments-___-IL---------------Size-�� _ _g_ --------Liquid depth------4— ------------- Cap ty---�Q-C) Disposal Field: sDistance from nearest. well�_4WNe._Distance'Jrom foundatio�t__;_L.f------.Distance to nearest lot line___-e]_______ Number of lines--------- -- --- L thl/of each line_�_.�---9�•��Q_'Width of trench_.--x---�-------------- Type of filter material-_ _ 1P- _�G e Fi'o{F filter material_---)__�__��___.___.Total length__ --c�- ------------------ r . Seepage Pit: Distance to nearest well_.N_A_ -C--Distance from foundation---Z_6_____.___.Distance to nearest lot line---- ._____ -- Number of pits--------/-------------Lining material__- r_l_C ,-Size: Diameter------ ----------Deptn_-0_-Z---------------------- Cesspo ol: Distance from nearest well________________Distance from foundation___-_____--_.__.,__.Lining material___.___.___._--______-________--__. ,._ gals. ❑ Size: Diameter `Depth----------------------------------------------------Liquid Capacity------------- ---------------1 Priv Distance from nearest weR__,____-----------------------------------------Distance from nearest building_______________-------------------------- y : - ❑ Distance to nearest lot line- --------------------------------------------------------------------------------------------------------------------------------------- - -------L4,T------T'n----4.a.�.c - - ' R�o�de in�d( or repairing�d scribe��.I.� �lS_�S_..-��--�$._:_��'r_�--------------------------------------------------------- it - ---------- - -------- ----- I hereby certify tha+ 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. o ----------------------------------------- ---------------------(Owner and/or Contractor) (Signed - - - - By:---------- • --------------------------------------------------- - - Title (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 APPLICATION ACCEPTED BY------------------------------ ------------- ----------- -------------------------- ---------- DATE_--------------------------- ----------------------------- - DATE- REVIEWEDBY--------------------------------- ------------ ------------------------------------------------------------------------------- BUILDING PERMIT ISSUED------------•-•------------- ------- DATE.. ---------- ----•-------- --------•------------------------------ Alterations and/or recommend ations:--------.---------------------------------------------------- ----------------------- -- ----------------•---- --------------------------------- --- ------- -• -------------------- ------------•---------------- i i f � � FINAL INSPECTION -BY:'-- --------- Date_...._. SAN JOAQUIN-LOCAL HEALTH -DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Tracy, California Stockton, California Lodi, California Manteca, California ee a oAA P.,AA W-710n