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10 ----------------------------- -- - APPLICATION FOR SANITATION PERMIT Permit No. ----------- ---------- ------------------- --------- --- (Complete in Duplicate) ' This'P&—mit Ex fires i Year From`Date Issued Date Issuedf � Application 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. JOB ADDRESS AND LOCATION___._ _ ._. __ .... SGC Owner's Name------ - ---�------ -------- - -c.. �---•--=------ ----------- - ------------------ �. . "r'_-�� # -- , —= one ----------- Address ---------------•--- --------------------------- Contractor's Named �h_lL �t LGA-- i ---- J - --"--•- •----------- _' � �-`J-- - -- --- =: ��•!4-hone..----•----------- •-------------- Installation will serve: Residence Apartmenf-House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other Number of living units: -1----- Number of bedrooms -_'-_Number of baths ---:_�-Lot size -.._ ❑ Water Supply: Public system Community system ❑ Private ❑ Depth tolNater Table ........ ft. Character of soil to a depth of 3 feet: Sand Gravel Sand , - Ciay" [IE] Y loam ❑ loam' ❑ Clay [] Adobe J Hardpan ❑ Previous Application Made: (If yes,date- J. No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF-INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool pe'rmitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weli_....�M__'Distance,from oundation__. .. ' � _ • F =�-- ----.Material-----�-fJt'c�C�L- ---------------- . No. of compartments--- �= Size- ` x - -----Liquid depth---- - ------ N -----------Capacity---- Disposal Field: Distance from nearest well s`_P Y,Distance from foundation---/-_ 1�-----"-Distance to nearest lot line---- ------ �___,• ' Number of lines._-.___-..".. g �D ' * r .. �---- �`�Len th of each line- -------------��--r-�---.Width of french----•�------.-�---------------- f Type of filter material..__ZJ� C'Y C_ `Depth of filter materiaL._...L-------------- Total length --------------------- �► Seepa e Pit: Distance to nearest well_..../o- _____._Distan e�from foundation-... :.a.�.' 0 �J l .._...Distance to nearest lot line-_-_.�1..___ �� Number of pits.._: ..-_ .._Lining material__,..__ f_"�C-Size:�[}iometer.............. ......... ! -- Depth. -� -- -2 Cess ool I p: Distance from nearest well Distance from foundation_. Lining material.. ❑ Size: Diameter----r-- . p ` = Liquid Capacity_, -- --- -- 9 ----------------De th---` - ----- - -gals. „ Privy: Distance from nearest well-----_c___.•___.__._ -"_- :__-___ Distance from nearest building , t _ g--------------------------------- ---- -- ❑ Distance to nearest`lot line.__ ----------------------- t i ---------- -•-------- --------------------------------------------------------- --------------- ---- I _-__ -------------- ----� 1 I Remodeling and/or repairing (describe):---------___---- ------------------- ---"---------------------------------- ! .................._-..-E.-- ......................................"...._--------- ordinances,.State laws, and rut " ept regulations f the San J""- "--"-- --or will -- n n - - r c -""- S------ -------------------------- 1 -ui - - Ihereby certify that I have pre orad this application and'that-the work will be done in accordance with San Joaquin County ; + oaquin Local Health District. o (Signed)- By: --- --- �- ---- .--- �-- - - - ---------------------{Owner and/or Contractor) BY: �t-- - - -- Title r (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 _ _ � --�- - - -- ----------- DATE 5 REVIEWED BY ----------- - ----------- f - -- •--------- --------- --------------------------------- - ---- DATE---•------------------------------- --------------------------------------- UILDING PERMIT ISSUED-----------------�----•------- ----- ----------------------- ----- -- --- ----------- ------------------------------- DATE...-------------------- Alterations and/or recommendations::sr-_- ..."..__-. . -------- ------------------------ --.------ --"--"-.-. - --------------- ---------"-----•-----------------------------•- ------------------------------------------- ................................. .........................................I--------------- - ---------- ----------------------------...._-- FINAL INSPECTION .BY,• ---._.. S Zd Date -----------------• ---------- --- ------- ---------------------- - SAN JO UIN LOCAL HEALTH DISTRICT 1601'6,Ha:elton Ave. 300 West Oak Street 124 Sycamore Street 205 Wes!9th Street F Stockton,California Lodi,Califorry a Manteca,California Tracy,California .ikf