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APPLICATION FOR SANITATION PERMIT Permit No. .- O_J�_.-.. (Complete in Duplicate) Date Issued --- 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. JOB ADDRESS AND LOCATION-------- G' � � -.(- ------- ---... .- -----•• -- --------------------------------------------------- Owner's Name----- ,y--G---C-p•----•--------A_6&............Co------------------ ----- ---------------"-----------------:---- Phone------------------------------------ Address-----------=20_ _.. ----" Contractor's Name- --- , --- C Installation will serve: Residence partment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms -------- Number of baths . ____ Lot size __ .___ eU-- A ---___ Water Supply: Public system N, Community system ❑" Private ❑ Depth to Water Table,— _. ._. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E2�,Hardpan ❑ Previous Application Made: Yes ❑ No Ej--. New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: ;e from nearest well --------------Distance from foundation-------------------Material------------------------------------------------- ❑ No. compartments--------------------------Size--------------------------------Liquid depth--------------- --------- Capacity----------------------- Dispos alrom nearest well___...._______._Distance from foundation____________________Distance to nearest lot line_______.._❑ lines-----------------------------------Length of each line-------------------------------Width of trench-------------------------------- Typ of filter material________________________Depth of filter material,_-.--_-_--__.___ Total length_______-_-_________________-____-______- �c 5aepage Pit: Distance to nearest well--- from #ou anon_ _!}__-___.Distance to nearest lot e �_... /' r Number of pits.____-!-___-__-_-.__Lining material__._ .A meter___.___��,�..Depth_._ �__________.____ Cesspool: Distance from nearest well----------------__Distance from foundation------.------------ Lining material__..___...._______._______-_________. .r ❑ Size: Diameter--------------------------------------Depth------=------------ --------------------------------Liquid Capacity_--------------------------gals. �? Privy: Distance from nearest well_________________________ ____________ _________Distance from nearest building--------------------.-____________.____._. ❑ Distance to nearest lot line-------=------------- ----------------------------------------------- "? Remodeling and/or repairing (describe):_________________________ ---------------- -_ .------------------------------------------- f ------------ ------------------------------------ ---------------------- ---------------------------- ----•---------------------------•----_....._.__-------------------•------------------------•------------•-•----•--------------•--------- --------------------------------------- -----------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------•--•--•-----------------------•--•----••-------------------------------•----------•----- I hereby cert' + I have prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, St a laws and rules and regulations of the San Joaquin Local Health District. (Signed)........ . ---- --- -- ---------- S- -- -{Owne and/or,.Contractor - ). 13 ,< -----------(Title) . . --- ------- ---- = (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 BY------------------- � - DATE---- REVIEWED BY--------------------------------------------' -_ DATE ------------------ --- BUILDING PERMIT ISSUED------------------------- -----•---------------------------------------• DATE.------------- Alterations and/or recommendations:----- - ------- --------•------------------------------------------------------------------••--- -- ��- ----........---_.. ---------- " r ----- -- -- -- ----- --------- - -------------- ---------------------------------------------------------- ------------------------------ ----•---------------------------------------------- F1NAL INSPECTION BY: .�-�_ _... �.-�------------------ - ------ ------ Date----� Y ` ----- ---------------------------------- 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 L E5-9-2M 145446 ATWpOb 12.54