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wFOR OFFICE USE: 9 ............ ---------- ----------- --------- APPLICATION FOR SANITATION PERMIT Permit No.-------------- -------4� - -- --- ------ (Complete in Duplicate) 0--� - ------ -- This Permit Expires 1 Year From Date Issued Date Issued Application 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 9rdinance No. 549. JOB ADDRESS A LOCATI N-_ X36- ---- - ----� Owner's Name = -- -- ---------------------------- - ----- Phone-------------- ------ -------------- Address-.___-_-_ ------------- -- ----------•---------------------------------------------------•-------------------------------- Contractor's Name ----------------------------------------------------- Phone----------------------------------- Installation - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __J___. Number of bedrooms _ ___ Number of baths __. Lot size _-._ ___ ___._ Water Supply: Public system 0Community system ❑ Private ❑ Depth to Water Table -k ft. Character of soil to a depth of 3 feet! Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date- ------ - ------- ) No []I'—New Construction: Yes ❑ No ER--THA/VA: Yes ❑ No [t}' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi anik: Distance from nearest well-----------------Distance from foundation---------.----------Material--- _________________.___.._.______. ------------ No. of compartments__ -------- ----------Size-------------------------- Liquid depth--------------- ------- Capacity---------------------- Dispos I d: .Distance from nearest well--— Distance from foundation----/Q--- ------Distance to nearest lot line_-� ____ Number of lines._ ------ _- ___-__- -------Length of each line-_STs--------------------_ Width of trench_,_ Type of filter materia;---_:_i��`t lG ----Depth of filter material_ ./_fj__`` _ _- ______Total length---.7..d_`-� _________ ------------- 6' Seepage Pit: Distance to nearest well-_ ---_-_---Distance from foundation___-fd__.__._.Distance to nearest lot line---- _ Number of pits______ __--.__------Lining material Size: Diameter___3_3-v ----- Depth ----_�sS`------------ Cesspool: Distance from nearest well ----------------Distance from foundation----------------- --Lining ❑ Size: Diameter. -_ _.------____ __-----__ --- Depth------------ -- ---------- -- --- ------------Liqu:d Capacity----------------------------gals. Privy: Distance from nearest well------------------------________---_-_ ___-_Distance from nearest building _.__-__-_____-__-__- ❑ Distance to nearest lot line- __- --------------------------- ____----- - Remodeling and/or repairing (describe):-------This_-_permit.-Application--is accepted to correct the immediate -- ----- - ---------- ------------ azarA._n -_tee age___ora__gro �3_ ____however;_-with n._one (l�-_year septic system must be brought to ----code ing_ an__ad.d1tjonal 1Q5 feet_Qf-_tile-_line- and an dd'tio .l 3 D-11--pit ------ ----- - -_f-p4- a -- ��-------- I hereby certify that I have prepared this application and that the work be done in accordance with San Joaquin County ordinances, State laws n�„�y�les and re do s of t e San Joaquin Local Health District. (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). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_______ _ DATE._____._. --'?v_�(� - ------ -- ---------------------- DATE BY---- --------- ------ . _ _ ----------------------------------- ----- DATE------- - - -- - ------- ----- --- - ----- ------------------------ BUILDING PERMIT ISSUED --- DATE-- Alterations and/or recommendations:___.__.____-_-_______ --------------------------- --------------- ------------- -----------------------------------•-------------- --------------------------------------------------------------------- -----------------------------•--- ----- ------------ --------- -------------------------------- --------------------------------- --------------- ------- ------------- ---------------------- - - ------------------------- r FINAL INSPECTION BY:----- _ __- - Date------ ____f -1~ P -,- S fJ QUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.