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APPLICATION FOR SANITATION PERMIT Permit No. .., .`{ .1 (Complete in Duplicate) Date Issued Issued ........L!_?-�... •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. 549. OOS-lfaD-/U 4f343 E• 37FHA.T • JOB ADDRESS AND LOCATION---- ---- .. :..---- [._ .-_ •--------...-•----.--.--- --- Owner's Name-•------GR.-T------Lt !! ^P.....p:. .................... Phone_-��-�2j ......... .� __-.-_--- ---. *....-..... ... . - .•...-.._-._....-...............---------.---------,-.------ .__._......._. Contractor's Name...........-.........._.................................................. .............................................................. Phone._.................. - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:....... Number of bedrooms ....... Number of baths ,-...... Lot size ................................... ._-------------- _...---- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ........ ft. 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: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feat.) Septic Tank: Distance from nearest well..,..-...........Distance from foundation..................Material................................................. ❑ . No. of compartments..........................Size................................Liquid depth..........................Capacity_.................. Disposal Field: Distance from nearest well----- 9".r...... Distance from foundation.....��!_.......Distance to nearest lot iine..1..*....... NumTypebof fifer mater el..>`.ri ;2 S - Length of each Iine...;..2i� ::::...Width of trenc7..._ ......................... De th of filter material........ Total len th._.. . ..........._...._.._..... Seepage Pit: Distance to nearest well......._.............Distance from foundation....................Distance to nearest lot line................. . ClNumber of pits..................._.Lining material.......................Size: Diameter..---.................Depth..............................,.,... Cesspool: Distance from nearest well.................Distance from foundation....................Lining material..................................., f" ❑ Size: Diameter.....................................Depth..-...........--........._........--__........Liquid Capacity......................._gals. Privy: Distance from nearest well...........................................-....Distance from nearest building........................__.............. .❑ Distance to nearest lot line...................._n..----......f--------------.......-./__------•--,-�---/--.........------------......-----...._........ ReModeling and/or rep firing {describeJ:.......- `�. t ? 1x4 f'L...r_.-.. ""7....11`._ _!�!'�...-.... ................e.......................................... -...... -.._..... ,e _.. .. ... ----------------------------------- "'A _ _ .J "'A ... ....J."..2_ ` -'!tF`.4..`------r.<t'.?! _A sn--._�.....-........_.......... ....-......---------.------....__....... -............ ...... I hereby certify that have prepared°this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a-nd_ rules and regulations of the San Joaquin Local Health District. (Signed)... / .-1 T' �.-..--- ..................... -........ ...... --- ---------------(Owner and/or Contractor) 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..Z.:w!zX7................-..---- REVIEWEDBY....--................................................._........ ..............-- .................................... DATE....,.....-..... ...........- BUILDINGPERMIT ISSUED..---__.............- ................._............................-........................ DATE_.............------------------------------------- Alteretions and/or recommendations:.................................................-......................................-...........................,........_.....................-....... .....................................................................................................................-............................................................................................-...... .............._........----..........._..--------.........._.................................................------._......................_..._-----....-......-._......................_-__----..-........ ..................................................._......•---...... ........._.........------.:...............- ........_..................................-.......................................................... .... - ..... _.....................-.......... ` ................ ........................ ------.........................._.......... • Date........-// I�?................... .......................FINAL INSPECTION BY:. '. .. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C"Street Stockton, California Lodi, California Manteca. California Tracy, California