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FOR OFFICE USE: - y s- - ---- ---------- ---- ---- y Permit No. --- 9 --- -------------- ------------------------------------- APPLICATION F4R. SANITATION PERMIT �-- ---- - ----•--------------------------------------- (Complete in Duplicate) , 3 /(a Date Issued ----------------------------------------------- ------- This Permit Expires 1 Year From 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 Ordinance No. 549. JOB ADDRESS AND LOCATION-�----_ ._. ------------ `.....------ .... :,. Owner's Name ------- C: Phone -------------------- ------------ f Address--------------- ------------------------------------------------------------- t----------••----------------------- Contractor's Name--------------•------- •-------------•-- .-••-• Phone-------_..._-----.------•- •-------" --- -------- -- Installation will serve: Residence 0 Apartment Ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -,/___ Number of bedrooms ._'—'Number of baths ____4 Lot size --------------- Water Supply: Public system [Community system ❑ Private ❑ Depth To Water Table 3_.5?! ft. Character of soil to a depth of 3 feet! Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ET—Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote--------------------) No [ ew Construction: Yes ❑ No [---FHA/VX Yes ❑ No a--- TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) DiOance from nearest well_________________Distance from foundation--------------------Material..-__-___._____.____________------.____._______-. l _ . . of compartments---------------------- Size-----------------------------..Liquid depth ---------------------Capacity--•---------•---------- a # posa F ted: Distance from nearest well_________________Distance from foundation.___„-_ .....Distance to nearest lot line___..f_-"- j Number of lines---------------- ---.__---- Length of each line--------_��____ ......Width of trench_______....._________._,__ r" Type of filter material._._ -Bepth of filter material___$'_�_f____Total length______________'j.... ___._._..__.__ Seepage Pit: Distance to nearest well------ ____Distance f m foundation____.U-___.Distance to nearest lot line__.-_.� ~E' v� Number of pits------- ------------Lining material_ , ----Size: Diameter- __1-----.Depth------- --- ------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------._______-----_ ❑ Size: Diameter----- -----------------•-------------Depth------------------------ -------------------Liquid Capacity- --------------------------gals. + --Distance from nearest building Privy: Distance from nearest well----- ----------------• -------------- - --- 9-- -------------------------------------- ❑' Distance to nearest lot line------------------------ ---------------------- --------------------------------------------------......-------------------------------------- I Remodelingand/or repairing (describe)-------------------------------------------------------------------- ----------------------------------------------------------.--•-----------------••------ --------------------------- -•--------------------•----------------------•-----------------------•-----------------------------------. ... I ------•------------------ --------------------------------••--'-------------------------------------------------------------------------------------------------------------------------••---------------------------------- 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 regulations of the San Joaquin Local Health District. ` -----------------------------------(Owner and/or Contractor) Si ned By:._----!�'��` ------- --------------•----------------:------;------------------------- •-----------(Title)----•----------- ------------- ..... -------- -- , (Plot pian, showing size ofI , locati6n of system in r ionlls, buildings, etc., can be placed on reverse aide]. DEPARTMENT USE ONLY r DATE l G APPLICATION ACCEPTED BY -- ---- - --------- REVIEWEDBY-----,� -- `------JN----- ------------- ------------------- ---------------------•-- ---------------------. DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------—--------------- ------ DATE------------------------------------------------------------- Alterations and/'. recommendations:--------------------------------------------------------------•----------•----------------- ---•- -------------------_----_-.... " `.fir .�•�-.- ------------------- .`s i ------- t ----------------------- -------------------------------------- •---------------•-•----------•-•-- ---------•------ :•-----------------•------•------------ -----------•--------------------------- - - - ------------- I FINAL INSPECTION BY:---f, __i � Date �jr C F I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California T Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-62 ATLAS i