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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ......:................. ----------------------------------------- -------------- -------------------------------------------- ._ (Complete in Duplicate) Date Issued ----------�_.-. ----------------------- _:_.___ -This Permit Ex ires 1 Year From Date=Essued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a_pplicaio n is de j compfia ce with o dinap �No. 549. S JOB AD KESS AND LOCATION r --------f......111. ,Qe ' - ' Owner's Name--- � E�'�-'----�s".��--- ------- - ------•-••------•------•--••-------- Phone----...,�� K -. _ !_�1-_.7-_____ _fZ• ..f. __ .r-------------------------.-----•-----.......-----------.._..---•--_•-___.....--------------- Address __-.-_____•_.• - Address.---••--f".----------••��,--�-----•-� '�'TM"r`� � Contractor's Name_' _ �------ ------------- ----------------------:---------------. -- Phone , Installation will serve: Residence ❑ Apartment House ❑ Commercial ,* Trailer Court ❑ Motel ❑ Other.N Number of living units: ___C.Number of bedrooms .--61 Number of baths -6_-_ Lot size ------- . P f Water Supply: Public system ❑ Community system ❑ Private JK Depth to Water Table___ ft. Character of soil to a depth of 3 feet: 'Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam I] Clay ❑ Adobe Hardpan ❑- Previous Application Made: ;If yes,date---------------_ Lam' .---) No New Construction: Yes o E] FHA/VA: Yes ElNo [P—' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) = fs Septic Tank: Distance from nearest well_5 :_--_DistanceIrfrom foundation--16... ------el t No. of compartments_- - �aL___�(rl� s-- _ s -- ----- Sizes ?� -"` .---Liquid depth---------`---------------Capacity-- •-- ' Disposal Field: Distance from nearest well-.,'C---4:-Distance-from foundation._16__-_----.Distance to nearest lot line__,�;...._�.__ Number of lines---..----t--- Length of.each line-----g ------------------Width of,.trench-------r1Sl°-------------------- Type of filter material---Kjo k-------.Depth of filter material----1 --------------Total length--------4 -------------------- Seepage ---------=Seepage Pit: Distance to nearest well----------------------Distance from foundation-----------------------Distance to nearest lot line_---_.-_-.--_--_ k ❑ Number of pits---------------------Lining material---------- ------------Size: Diameter--------.---------------Depth---------•----------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---.--___--.--r_.--.Lining material---------------------------------- I] Size:';'Diameter---------------------------- Depth-:--------------------------------------------------Liquid Capacity----------------- gals. Privy: `.Distance from nearest well--------------------------=-__-------- -.-:.-Distance from nearest building------._---_-_.---_-..-_-______.--------- . _ • ❑ Distance to nearest lot line ------- ----� - ------------------ - --------------------•--------•-------------------------------------------•----------------------- Remodel'ng and/or repairing (descrbe�:----_-.�'ns.G�__1t � - 1 "- -' ' .'•" n .�� ---------- ---------------•----- ------------------- ---------------------------------------- --- ___________________________________________________________________i----_--...-.-_-_---------_-_---'.._--__----_---..-----____...______-__---___•_-----.-.-_-----__-_------_-_-_-..»._---_.-------------.._ ______.___._.. + -----------------------------------------------------•----------- -t____________________________________________»_--------.__---------------------------------------------------------------------------------------.------ I hereby certif .y,that I have prepared this'application and that the work will'be done in accordance with San Joaquin County ordinances, Stat aws, and rules and reg ations of the San Joaquin Local Health District. . a orContractor=-- ---- - --- ------------- ------------------------------=----------------•---------------- ..Owner and (Signed --•--- -- '. -=- ----•---- -- ------ -- ---- - / ) (Plot plan, showing size of ot, location of syste relation to wells, buildings, etc., can be placed on reverse.side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------` =---- - ---- ------------------- •-----------•------- DATE--------- -- ------------ f ; s REVIEWED BY------------------------- -------- ---------------------------------------------- ------ DATE--------------------------------------------------------=-- -- - - BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------•-------- DATE.------------------------------------------------------------ Alterations and/or recommendations----------------------- '---•-------•--------------------•------------•--------------•--------------- -------•------- ------------------------------------- ------------------------- � FiNAt INSPECTION BY:'s -----_._ ___ _ __.__..---_. ._ - 'Date........� ".- -------------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 905 West 9th Street Stockton,California Locil,California Manteca,California Tracy,California ES-9 REVISED&-39 F.F.00.7M 6.612