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FO •OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --------------:-------------- -=-`F''=------------ -------- --------------- (Complete in Duplicate) Date Issued _Z1-�-� _-___._-- 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. moi, This application is made in compliance with County Ordinance No. 544. JOB ADDRESS A OCATION____ .- ---1----• ----------------------------------------------- Phone ----•--------•--•-• Owner's Name --------------------------------------------------- Phone--.....-•-----------------••-- �J,_ - Address `" /'x!'L ( _ ----------------------•--------------------------------•--••---------•-------...................................................... Address Ph ..�.--------------------------------•----------•--------- ---- - one.................•---------------•- _ Contractor's Name---- -��. 5----------------- - Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House-,[.] ❑ --------- Number of living units: ._-___ Number of bedrooms 2 Number of baths .....t., Lot size __��--- ------------••------• -- I Water Supply: Public system 2*' Community system ❑ Private ❑ Depth to Water Table._ ft. Character of soil to a depth of 3 fee;: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ FHA/VA: Yes El No ❑ Previous Application Made: (if yes,,ltote--------------------) No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within X00 feet.} ._ Material---•----------------------------------rte. Sep Tan Distance from nearest well-----------------Distance from foundation-------------------- -Ca aci �� --------•-Size-------------------------------- ion-. --•--•--- --------- -=-- Liquid depth Capacity �... No. of compartments_____________ _ -• - Disposal Field: Distance from nearest welly -----Distance from foundation_.��.............Distance to nearest lot line.... Number of lroes-------------- ------•------------Length of each line-------- Q.- - ----------.Width of trench-------- - r I ` Total length _ Type of filter material._-790-t-K-------Depth of filter material___) _ __________ g See a Pit: Distance to nearest well ------Distance f foundation_1/lf_ rr►_.Distance to nearest lot line____________.. Number of pits--i-_--I--------------Lining material------14Q_d1_.---Size: Diameter----3-------_--. --.Depth_.____.---•��...------••- � l ___________Distance from foundation-___--_-__________,Lining material_.-.__.___..__-...__.._.____...._alS Cesspool: Distance from nearest well______ ❑ Size: Diameter_'_: ----------------------------------Depth ---------------------------_ Liquid Capacity g Privy: Distance from nearest well-_..____._______________ __ ------------------Distance from nearest building--------------------_---•-----.......... ❑ Distance to nearest lot line------------ ----------- p. . Remodeling and/or repairing (describe)----------------------------------------------• ----------- ............. .... i ------•----•---------------------•-----•------- ------------------------•----------------- 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 4,eS Joaquin Local Health District. Si ned _ - ---- -- --- -•-------------------------------------------- (Owner and/or Contractor) ---- ---------------_----- --_- ----- (Title)---•-------•-----• -- ---••--------------------- -------------- By:... - (Plot plan, showing size. of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse side}. FOR DEPARTMENT USE ONLY o APPLICATION ACCEPTED BY_ � _--, ;--=------- "- " •-------- DATE. - -"--- ----------- - •. ----- DATE-------------------------------------••---•---------- REVIEWED BY--------••------------••------ ------------• ---------------------------------- -•----------- - - BUILDING PERMIT ISSUED__. -- DATE Alterations and/or recommendations--------- ------------------------- ----------------•----------•------------------•------••-•----.-_--------•-----•-------------•----•----------------... ------------------------------ ------- -------------------------------I—---------------------------------------------------------------------------- ---------------------- r ---------- Date__. �.Q..' ' FINAL INSPECTION BY:------- --- r _ ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Soo west Oak Street 124 Sycamore Street 205 West 91h Street r Stockton,callfornia Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-99 RM 8-61 ATLAS