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F/9,R OFFICE USE; CPermit No....� APPLICATION FOR SANITATION PERMIT ------------- --- - -------------------- ------------------------- -- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date'lssued ict for a permit to construct and Application is hereby made to the San Joaquin Local Health DistrMall the work herein described. This application is made in compliance with County Ordinance No. 549. „f. JOB ADDRESS AND LOCATION _%f 'fir-----=��1 4 I ` �`-------------------------------------- Phone. Owner's NameCf*�" _ ____ y �� y f------------------------------------------------------------------------------------------ Address Contractor's Name ---------- "--�t--•-•-----:_...------�'-----�•--=---------- • - = ... Phone �?r` Installation will serve:,:�Resicience M --.-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of,living units:.___ Number of bedrooms . Number of baths -__�-- Lot size �..r=---••-�—fes' _i y/1 Water Supply: Public system ❑ Community system ❑ Private 4 ,Depth to Water Table -------- ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam '[IClay E] Adobe Hardpan C] r FHA/VA: Yes No ❑ Previous Application Made: (If yes date -------------------- } No ❑ New Construction: Yes ❑ No ❑ ❑ �} TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank`or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well____ K__1Distance from foundation_--_/'-, ------- mate rial__%'---°l C` ------•----• No. of compartments ------- .-_------- .Size ---- apacity_-_--------:8.------- Disposal 1 ie4d:.pt Distance from Barest well._,Distance from foundation---- a -__.Distance to nearest lot line-__. �_ �. i +f 44 Number of lines_________________ _ Length of each line_�.�'--� 'r9!14idth of trench --_____:--------------------------- J9 --------------- - ----- -=----- i Type of -filter material--------fol-e- ---Depth of liter matenal__-_`------•--Total length-----^ ------------------•-- Seepage Pit: + Distance to nearest well _____________________Distance from foundation ____-_-_-___....__-.Distance to nearest lot line ----------------- Nuber - _ mof pits=----------------- - -Lining material --------•--------;-----Size: Diameter ---- •------------------ Depth--------------------------------- Cesspool: ---------------------------- -Cesspool: Distance from nearest well ----------------- Distance from foundation -------------------- Lining material ______-________--_._____________-_-. ❑ t Size: Diameter-' --------------------- Depth ----------------------------------------------- = ---_Liquid Capacity -------•------ -- - - •---•-.9 f. _Distance from nearest building.-.: Privy: •Distance from nearest well----=------- - -•------------------------------ 9--=--------------- ----------------------- ❑ Distance to nearest°lot line------------------ --------------------------------- ---------- -- - Remodeling and/or repairing (des Tribe):------------------ t --------------- •--------------------_ ----------------------------------------- ------------ (. --------------------- --•-------------•-•-------•--------- ----- k ---------------------------------------------------------------------- :..`_------------------- ------ ---- --------------------------------------------------------- -- -- ----------------------------------- ---------------------- - --------------------- 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. ZI - ----- ------------------------------------ -----------(Owner and/or Contractor) ;= -----------------(Title)------------------------------------------ - ------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can beplaced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---_-_ ___�_____ --_ --_ --------------------------------- REVIEWEDBY- ----------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------ ---------- •-------------------------------------------------------------------------- N --- _ . Alterations and/or recommendations:,.---"--.-,-,."-,—, - -------------------------- DATE ---- ecommendations,.---=--.--:'_'---------------------------- DATE----' '— ��- --- ---4---_`_-------- DATE------------ ----------------------------------------------- DATE------------------------------------------------------------- ----------- -- -- --- --------------------------------------------------------- ---------- ------- -- --------------------------------- FINAL INSPECTION 'By-`----------- Y'` Date.-- y -n-----------1-------------- -- -----------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton, California Locil, California Montero, California Tracy, California ES -9 REVISED 6.99 F.r.CD. iM 6-60