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- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) GCGc_•.�LE.. e'�-v�- # Date Issued(.)-__'�_:__�`_'� Applica�ion is hereby made to the San Joaquin Local Health District for a permit to co st and install the work herein described. This application is made in compliance with County Ordinance Na. 549. Q--� Aoc Jc& JOB ADDRESS AND LOCATION..__-ZJG --- .- A�253 Owner's Name------------- ------------------------------------------- Phone,f7Ttt.c 1--•--- Address__.. v--- -- -- --------------------------------------------------------------------------------- --------------------------- Contractor's ----- -------------------- Confiractor's Namecer - �t�-t1----------------------------------------•------------------._ Phone-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _____ Number of bedrooms _j__ Number of baths __l__ Lot size ----Iln.,�—___________________________________ 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 p Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 9j-"'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 feet.) Septic T . k: Distance from nearest welf_ --Distance from foundation__�0_ ____-Mat rial--_ -__- __ �y 13 • No. of compartm ---- depth � -_____CapacityPO_ ______ Disposal Field: Distance from nearest well- Distance from foundatio __140__"–------Distance to nearest lot line�l��_... Number of lines--------Z----`- /S-. Length of each line----.�O_"---------------Width of trench__�4Z"------------------- Type of filter material___I y..__1-..---Depth of filter materiaL,��_-------.--Total length____f2-Q�___________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line________--__-__ El ------Size: Diameter----------------------- h-------------------------------- -- Dept - hum Number o pits______________________Lining material______________._ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- 0 Size: Diameter------------------ ------- -----------Depth---------------------------•------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance frem nearest building--_________---_-________-_------_-__._. ❑ Distance to nearest lot-line------------------------------------ Remodeling and/or repairing (describe)--------------------------------------------------------------••------••------------••----------------------•-------•----•------•---------------------•-- ------------•--------------- --- --------------------------------------------------•• _-------------------------------------•---------------------------------------------------------------------------- -------------- I hereby ce if that I h ve prep red this app pp' and that the work w'll be done in accordance with San Joaquin County ordinances, Stat I s, and les and regulations f the S Joa uin ocal alth District. (Signed). ------------------ ----- -- - ------ --- -•• --- -- Contractor) B : (Plot plan, showing size of lot, location of system in rel on to we11s, buildin , etc., can be aced on reverse side). FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - -��- -r----------------------------------•---- •---------------.. DATE----A-,----`-.� �-�►--�•-------------------` REVIEWEDBY------------------------------------- --------------------------------------------------- - --------------------------------- DATE ! BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations------------------------------------------------------------------------------------.------------------------------------------------------------ --------------------------------------------------- ..... -----•----•-----------•-----------------------•-------------------------------•----------------------------------------------------------------------------- --------------•------••---------------------•----------_....-- FINAL INSPECTION BY:.. AV_ ------------------ Date. ../../r�K.------------.---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Americah Street 300 West Oak Street 132 Sycamore Street 914 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California 5-7 b ES-9-2M Revised W-2100 ��'