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FOR OFFICE USE: p ------------------ _: +�_____________ APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) JDateThis Permit Expires 1 Year From Date Issued Issued _ __� Application is hereby made to the San Joaquin Local Health District for a pit to onst ct and i all the work herein described. This application is made in compliance with County Ordinance No. 549. 7 JOB ADDRESS AND LOCATION---- ` - -j --A0,0,k A"--------- - ---- - G__ (✓C--_. '��I _1 /t' Owner's Name--- / ----------------------------- - -�-�� ------- - -- ------•------------------------------ Phone---------------------....-----• , Address------- - ---'-------•-•------------------------------------------------L--------------•----------- Contractor's Name---- /---------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__ Number of bedrooms._-?__- Number of baths _4-_ Lot size -49' �- _'_____________________ Water Supply: Public system ❑ Community system E] Private � 4+ _epth to Water Table ft Character of soil to a depth of 3 feet! Sand ❑ Gravel ❑ Sandy-Loam ❑ a Clay Loam ❑ Clay ❑ Adobe&--�Hardpan ❑ Previous,Application Made: (If yes,date------------------- ) No New Construction:-Yes ❑ No F��Fh{A/VA: Yes ❑ No D— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is availa6le within 200 feet.) Septic Tank: E Distance from nearest well_________________Distance from foundation---------------------Material-------------------------------------:---_------ - Disposal Field:, QDtanc-e fropm rnearest well-.- �_____D stance-fro----------------- ----- ----------Liquid depth-------------------_------Capacity-..-------------------- ' m-foundatic.n " 00__-__-Distance to nearest lot line__mom""_.._.. ',-EW�;, Length of each line--,"10Y- Width of trench ____-____,-___-_-.----_--__-- Number of lines___r__/r_�-____ �y rn Type of filter mM rial,-,-* XW-Depth of filter material----/ ____Total length�,�_-_ tt i Seepage Pit: Distance to nearest well----*-O"Pe___Distance from fo ndafion-%-7L9-------Distance to nearest lot lin --- --- Number of pits--__V_____________Lining materidl' --.Size: Diameter -----..-__Depth ��~tif.� Q' Cesspool: Distance from nearest'well------------------Distance from foundation_----- -------------.Lining material-------------------------------------- . - [❑ Size: Diameter----: ------------------ -----------Depth----------------------------------------- ----------Liquid Capacity--.--- -------gals. Priv Distance from nearest well----__-____-_-_: Y= _� -------------------- ---------Distance -from nearest building------------------------------------------ ---- - -- ------------ --- ❑ Distance to nearest lot line --- -� --------------------------------------------- -------------------- - ---------------- ---------- o rJ Remodeling and/or repairing (descriG�):-- --------------je --------- ------------------------------------------------------- 1 �-i ---•5----- ---------------------------- I hereby certify that I have prepared this application and that the work will be done'in accordance with San Joaquin County ordinances, State laws, and rules and re atio of the San Jos m Local Health District. r¢ - (Signed)------------------------------------------- r - ------------ -----• -----------------'(1E6=e=*a%h4or Contractor) By:------------------------- -- -- ---------- ------(Title)-- _ ------------ ---------..--------. . (Plot plan, showing size of lot, location;of system in rela o to wells, buildings, etc., can be placed on reverse side). ft FOR DEPARTMENT USE ONLY i __ DATE--._ ----------------- -== --6----- ------------- APPLICATION ACCEPTED BY_ ---- -- REVIEWEDBY------------------------------------ - -------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT. ISSUED---------------- }------- ---------- ----------- -•- DATE ---------- Alterations and/or recommendations:'*-- _ ------------------------•------ --------------------------i --- ------------------------------------------------------------•------------------------ ---------------------•---- ------------------------------------------------------------------------ ------------------ -----•---------------------------------------------------------------•- -------------- ------------------=----------------- 1 ---- ------------------------------------- ----- ------- ---------------------------------- 1-------------------------- ------ ------------------ --------------------------------------------------- ----------------------------- ----------------------- --------- - -- ------------------- -------- iFINAL INSPECTION BY:--- --- --- --- Date------------------------------------------- ---------------------- -------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:etion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California w Manteca,California Tracy,California F.P.CC.