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(PI APPLICATION FOR SANITATION PERMIT Permit No. ___...._. (Complete in Duplicate) s _Date Issued 1 Applicakion 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. JOBADDRESS AND LOCATION---------- ------------------ [ -----------'------------------•--- ` ---------------------------------------------------•----------------- ---------- Owner's Name------- ! -------------------------------:------------1---------------- ------------ =-.Phone.......--------------------------- .� . e Address- 'f�`,� - / .------. ---- ... Contractor's Name - ---1---- `GSC --------------------------- Phone../ ` _ =_v_la-_- Installation will serve: Residences ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other a-c Number of living units: -4? �_ o� Number of bedrooms __ _-_ Number of baths ______-. Lot size_ '_______________�3.___________________-___ Water'Supply: Public system ❑ Community-system ❑ Private- Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam.❑_ Clay Loam❑ Clay ❑ Adobe®'Hardpan ❑ Previous Application Made: Yes ❑ No 2-'-New Construction: Yes E9-110 ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,49ep ' TQnk: Distance from nearest well_________________Distance from foundation--------------------Material__________._____-_______________------__._____- 41 No. of compartments--------- ----------------Size-----•------------------------- Liquid depth--------------------------Capacity----------------------- isgo. l IlField: Distance from nearest well-----------------Distance from foundation-------------------.Distance to nearest lot line__-_____-______- `� Number of lines-----------------------------------Length of each line--------------------------_--.Width of trench-----------_-----__---------------=- U Type of -Filter material-------------------------Depth of filter material--------.--------------Total length-------------------------------.__________ � Seepage Pit: Distance to nearest wellv._._-___Distance from fo ndation__-.` _____________Distance to nearest lot line----------------- Number of pits-------�----------Lining material S!_ _ _�N e ---Size: Diameter----� ..--------..Depth-----c3 a- Cesspool: Distance from nearest well-----------------Distance from foundation_____..___.____-.-_Lining material_______________________._.________. ❑'' Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. , Privy: Distance from nearest well------------------------------------------------Distance from nearest building-----------------------------------------. El Distance to nearest lot line----------------------------------------------- -, - Remodelangand/or repairing (describe):------------------------------------------------------------------------------------------------ -----------------------------------------------------••- ----------------•------------------------`---•--------------------------••------------•-••----------------•--------------------------------------•--------------------------------------- ---------------------------------- y _____ __ __ ________________________ ______________________________________________________________________________________________________________________________________________________________________________ I hereby certify that 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. . 5i ned -------------- ------------------------------------------------------------------------ ---(O ner and/or Contractor) (Signed) `-r� 2. f-!� „ ---------------------------------(rtiel =-----'�--- ------------ ---- (Plo+ plan, showing size of la+, location of ys+em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY J APPLICATION ACCEPTED BY--------------------------------------- ------------- DATE---- -------7.--` ": ----'--------- - 1� 6 REVIEWEDBY----------------------------------------------------------------------------------------=------------- ------ DATE-- •----------------------------------------------=--------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-----------------------------------------------------••----- Aiterationsand/or recommendations------------------------------------- ----------------------------1• ------------•-------- --------'-------••----•-----•-------.------ -•-----•------------------------------------------------------•-------------------------------------------------------------------------•- ---------------------------_-----•-----••------•---------------------------------- ------------------------------------------------------ -•----- ---------- •-•---••.......------------- -------------•-------------------- --------------------•--------._-...-------- ---------------------------•---•-•------------•----------•-----1---------------------- a Date -- "� jr FINAL INSPECTION BY-------------- -------• ._... -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stock+on, California Lodi, California Manteca, California Tracy, California F ES-4-2M - Revised W-200 „�