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FOR OFFICE USE: -------------------------------------------------------- Permit No. •--- ••---- •---- --- ---- -- - APPLICATION FOR SANITATION PERMIT , in Duplicate) -------------•.......--.}� {{-� � (Complete p� � •Da#e Issued -----••-- "� ,a-..---"i-f-_.V.__.-.----._.- TkisrPermit Expires 1 Year From Date issued Application is hereby made to the'San Joaquin Local Heellh,District for a permit to construct and install the work herein descrbed. This application is made in compliance with County202- ante No. 549. JOB ADDRESS;A. i. .� -------- CION---' / . :-�' - - -----------•--•-- -------------- Phone-_-------- Name --------- -------------------- Owner's - Phone..... t _ --... -•----..---_e ..----- •- Address -------- Ph -----------------• l t on -- .... .. (� Contractors Name............... ... - Installation,will serve: R sidencef 21 AApartment`mouse❑'�Gommercial'n t Trailer Court ❑ Mosel ❑ Other Of �� /aa------------------------- Number of living units: -fr-- Number of bedrooms -- Number of bths _ ._.-_ Lot size ....-..,_.------ .- Water%uppljy Public sy1fem ; Community system ❑ Private ❑ Depfh to Water Table' Character of'soil to a depth of 3lfeet- Sand E] Gravel El Sandy Loam ❑ , Clay Loam [I Clay ❑. Adobe Hardpan C1 Previous Application Made: ='(If yes-cicite----------------'i1 No ❑ New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND(SPECIFICATIONS! r # *Disposal No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' t � + ank:` Distanc� from :nearest well-----------------Distance from foundation-_-_---:---:.------.Material..------"._----....----_.............._..--_..... No. of compartments ----------Size--------- -----•---------- --ILiquid depth_... ..-... Capacity ........-....57 F ld: Distarcefrom nearest wel�/�-Distance from foundation.--/0...__--..Distance to nearest lot line Number of lines------- -- ---- ---.---Length of each line/ .--".-_-_- --�_- Width of trench--_- ---.....---...--.---....-- Total length Type of filter material_.�—,t a.-"-Depth of filter material-.. --_-_r---- g \ t Seepage,Pit: Distance ito nearest/ell f nda tion__2�._--•-_.Distance to nearest lot line.-�=-.-... Number bf pits.-----r "------""--Lining material-� -.Size: Diameter-_-- - -'-- ---.Depth---- - ----•--------.... Cesspool: Distance from nearest well"_;- ;Distance from,foundation--------------------Lining materia!_._-------_-.__---- .----.-....-_- Size: Diameter------ ------------------------------ Depth---------------------------- --------------------...LlquidiCapacitY gals. ❑ + --.-Distance from nearest buildin Privy: Distance from nearest well 9 ❑ Distance.to nearest lot line- ---------------------•---------------------- -----------------------.......-- k l , ( Remodeling and/or repaIring (describe)----------------------------------------------------------------------------------------------------q i -----•-------•---------------••----------------••----------••--"------------------------------------------------- .................-----------•------•----------•--------.--------------------.-----------------------------------•.....--------------------------------------------------- -----------------------------------------1---1--•-•----------••----------------------------------------- --------•------....__....------------- ----- -------------------------....----••------•------ -------------- I hereby qr4ify +hat_I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, at laws, an iules and re lations of the San Joaquin Local Health District. } {Signed) ----------- --------------------- er and/or Co actor) d/o Contractor) By:....................... ...... ----- -- ------ - -------------------------{Title)------------ --- w Plot plan, showing size of 40 ; location of system in relation to w s, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ------- ---- --I------------•----=---- -------------------- DATE-----r �'J�--•"-------- 2____-----.: I ---- REVIEWED BY--------- .." ------ ------------•----- -------�-:--------_--:----•:•-------------.DATE- _ a BUILDING PERMIT ISSUED._......,--�---'------ QATE.. 4 Alterations and/or recommendrations---------------------- ------••----------•--•----•----------•----•-------•--•--•------------•------------- -•.---••................•----•-----•-------•-----------•-------------------•------------------------- ------------------------ ..... - --------------------------------------- __..... --------------•-•------"---------------------------- -------------------- - •----------- • .................... --- - FINAL INSPECTION BY:--- r Date------ - �----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT lik, 130 South American Street 300 West Oak Srresit 144 Sycamore street 405 West 91h Street Stockton,California Lodir California Manteca,California Tracy,California ' E8 9 REVISED 0.59 8M 5-61 ASLAB