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/ APPLICATION FOR SANITATION PERMIT Permit No. 4a..k!... (Complete in Duplicate) Date Issued T lication is hereb made to the San Joa uin Local Health District fora ct I _ Oghe wa7 pp y q permit to construct and install.the work erein described. This application is made in compliarice wy'th County Ordinance No. 549. JOB ADDRESS-A LO I N-- ----• --- ----�/ � i Owner's Nam G--- ------- ----- - ------ - --- - Address = ----------- Contractor's Name----- -- -------- ------ ----•------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms -2-_ Number of baths I__ Lot size ______-- Water Supply: Public system ❑ Community system ❑ Private EZ Depth to Water Table 3_Q ft. Character of soil to a depth of 3 feekt: Sand ❑ Gravel ❑ Sandy Loam�_,( Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ . Previous Application Made: Yes [:]I No New Construction: Yes No ❑ N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available-within 200 feet.) I - Septic Tank: Distance from nearest well__l.7_l Distance�fom fa�ndat�A r�_ -�__'__.___.M ter' I" __-- No.' of compartments____-._ -,____ Size__3_�_ iquid Disposal Field: Distance from nearest well/�AO�_Distance from foundat1 n__-a!!:- _"_._._.Distance to nearest lot line_ -_____ Number of lines---- Len th of each line_____ _ ____ i___--._.Width of trench._ - _____..._-__.________-- ; 9 Type of fitter materiaLE_y_-/ -Depth of filter material_____ _____________Total length---�'--________-_-_-_-__-_______- Seepage It: Distance to nearest well---------------------- from foundation------------------- Distance to nearest lot line----------------- F1 Number of pits---'--------------------Lining material----------------------.Size: Diameter----------- ----Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material------------------------------_- - ❑ Size: Diameter----- ------------------------------- Depth--------------------------- ---------------- ------Liquid Capacity- -"------------------------gals. Y. _e ,_o ., F Privy: Distance from nearest v✓elle ___ ____Distance from nearesT buildin - Distanceto nearest,lot'line --------------------- ------------------------------------------------------------------ ---------------------------------------- I N Remodeling and/or repairing (describe):-------------------------------------_------------------.----_ V► 1 ----------- -------------------------------------------- --•---------•-----------------•---------------------•------------------------•-----------=---------------------- ------------------------------------------ - ication and that ordinances,bStatrtlawsh ndh ules and red latio golf the San Joaquin Local HealltheDi frit+� accordance with San Joaquin done County (Signed)-.- - ---•---- _ ----------- --- -------------------------------------------------------------------------------------------(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). a r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- -------•-------------------------- DATE------- REVIEWEDBY------".--------------------------------------------------------------------------------------------------------------------- DATE--------------------------------------- - BUILDING PERMIT ISSUED-------------------------------------------------------- ----------------------------- --------- DATE Alterations and/or recommendations:--.____________________________ --------------------------••-------------------------------------------•------•-------------------• -----_--------------------------------------------------------------------------------------------- ----------------------- ---------- ------------------------------------------------------------------Y --- ---- ;------------------------------------------------------------ = _ ------------- FINAL INSPECTION BY----- -------- ------------------------------ Date-- �" - SAN JOAQUIN 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 k 'ES-9-2M 10-52 Revised W-2104