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APPLICATION FOR SANITATION PERMIT Permit No. -7"-1.___3— (Complete in Duplicate) Date Issued .11121 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. aw)o ff'' _ . - - •- -�can- ----------------------------------------------- JOB ADDRESSAryN-�D LOCATkO11N,_---�_---T-� ! ,. Owner's Name--- r�'. ....-•---.( -1 '------ f 1, -------------- Phone---z ycT ------------- in - ��-��c�-----�.a_!?y-+.°..,a__---`-"-��---•-`-�-5----�.�a�-u ---------------••-------- , Con#ractor's Name GC1`" ' ---- Phone. .... Installation will serve: 'Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1------ Number of bedrooms _. Number of baths.-_1----- Lot size _--_-- --2-------------------- Water Supply: Public.system El Community system El Private �th to Water Table 4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam �Iay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ a TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--1__ v,-__Distance from foupdation.----A -------.Material------------- ----------------------------------- No. of compartments-----2-------- -----Size-_��--�_� ---------Liquid depth-----4-----------------Capacity_.--Sp�-�-•---'-'-]- Disposal Field: 'Distance from nearest well-45.0- Distance from foundation_- -4-2Distance to nearest lot line----------------- fof lines--------2---------------------Length of each line-----�2-__--_- ---It-------Width of trench---- -- -- ------------------ Type of filter material-$;T�_&!t-k-.---Depth of filter material----- - ---.......Total length---------1--+Z-a----_--____.------..- LF Seepage Pit: Distance to nearest well-------------_-------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------- ------- Depth Distance from nearest well-----------------Distance from foundation-------------------.Lining material_-..___-._.----.----_-_-----_-_._-_-. ❑ Size: Diameter--;------------------------- --------Depth----------------------------------------------------Liquid Capacity----------------------•=---gals Distance from nearest well---=---------------------------------------7 Distance from nearest building ------------------- M -- ❑ Distance to nearest lot line----------------------------------------------- -------- ----------------------------------------=---------------------------------------- I Remodeling and/or repairing (clescribe)----------------------------------------------------------------------------•-------=-----------•--------------------------------•----------------------- - ` -----------•------------- • ---------•---------- -------------- -----------------------•--------------------------------------- ------•--------•-----------••------------------------------------ ---------------------------------------------------'. --------------------------------•--------•-----------------•-------------------------------------•----------------------------;--••-------------------------------- I hereby certify that 1 havierl;repared this application and that the work will be;-done in accordance with San Joaquin County C ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i (Signed) nr__ lirA �------------------------- ------------------------------------------------------------------- (Owner and/or Contractor) 1 '` _ _ (Title) ----------------- ---------------------------------------------- (Plot plan, showing siie of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 3 FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY------- --- --------------- � 2 � ---------- - DATE------ •--------------------DATE I -�1 --•--• 4 � __ _ . .. REVIEWED BY--------------------------------- I ----- 1 -- BUILDING PERMIT ISSUED-------------------------- --------- -----• DATE--------------------------------------•---------------------- ------------------------------------ -- -- Alterations and/or recommendations:------------t ------------------------'....................•------------------------------ f -------- --------------------- -------------------- --------------------------------------------------------------------------------------------.--..--•------------------- ------------------------------------------------------------------------- l� a / ---- -------- ----,-- ---- ---------' /✓ ----------- --------------------- -----------------•-------------------------------------------------------------- -------------------------------------- ----- ----------------- -------- --------- -------�----•-------- ---•-------------- --- -- FINAL INSPECTION BY: --------- - ,=="= ----- Date---- --- -- ---� --------- ---- ------------------------••-- f SAN JOA QUIN 'LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street ,814 North "C" Street Stockton, California Lodi, California Manteca, California —"°"Tracy, California rc 0..__')k. - R--A w_?inn