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e—Lx APPLICATION FOR SANITATION PERMIT Permit No. ------- (Complete in Duplicate) A Date Issued -----/-o/i.-- --___ Applica{ion 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. S49, JOB ADDRESS AND LOCATION 1871 9th.__5treet. Stockton ----------------------------------------------------- Owner's Name___________ -_---- QRS._ _BER`!!HA CROSS .. Phone.-----HO 35489 - - -• -- Address.------• ----------------------------------------- ------SaYne--------- ------------------------------------------------------ C Name.----`-------DaPalk��_s--aeptic._ __Sert+xCe Phone HO 2'704b ----- ---Y- -- -- Installation will server Residence [2 j Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.._ Number of bedrooms ____ _ Number of baths ------ Lot size ______S4t___�__12--_-______________________________ Water Supply: Public system [2: Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe I; Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ NOR F 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------------------Distance from foundation---------.---------Material___-----------------____.._.________..__________- jj�istin No. of compartments--------------------------Size-------------------------------Liquid dept h----------------------._Capacity---------------s------- Disposal Field: Distance from nearest ell--- one_..._Distance,from foundat-so _ _�20.._____.__Distance to nearest lot iine____5�__..... Number of lines-----------�---------------------Length of each line-------��-----------------Width of trench---------------------24--_------ Type of filter materiial_S_48'.)CC__ _Depth of filter material---------1$�._____-Total length........_5_.0t-____-__:___--__-_-_--___ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- 17-1 Number of pits----'--- ..Lining material-----------------------Size: Diameter--------------.--------Depth------.-------------------------- I Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.____..___._._____.________________. ❑ Size: Diameter--- ---------------------- ----------Depth----------------------------------------------------Liquid Capacity--. ------------------------gals. Privy: Distance from nearest well---------------_---------------------------------Distance from nearest building------------------------------------------ F-1 ___.____.____._________ __._.❑ Distance to nearest lot line--------------=------------------------ ------------------------------ --•--------------------------•---------- Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------•.................. 1. ---------------------------------------------------------------------•---------_---------------------•-----------------------------...--•----._.....------------------------------------------------------------------------- I hereby certify that I have prepared this applicati n an that the r ill e d ne in accordance with San Joaquin County ' ordinances, State laws, and rules an,d,regulations. of +he San Joaquin L I ea D' trict. (SignedDag's.Septie Tar& Service, ------------------------------ By:------------------------------ -- - - -i ------ --- '- Title) Vier - - - --------------------------- (Plot plan, showing size of lot, location of system in r a Eon to wells, buildings, etc., an be placed on reverse side). _77F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ---------------------------- -------- •--••---- 1--�- DATE------------____-- REVIEWED BY--------------------------------------F--- -------- ----------------------- S -•-------••-•----•------------- - DATE------ -- ------ ._..- BUILDINGPERMIT ISSUED.-------------------------------------- -------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:!,- ------- ---------------------------------- ---------------------------------------------------•------------------- 1 --------------------------------------------------------------- -------------------------------------------•--•--- ----------------------- •---...._........_..--------------------..-•---•-----•--•-........_•--.----- I ---------------- -- ----------------------•-------------------------------- ------------------------------------------------ ----------------------- --------------------- ----------------- FINAL INSPECTION BY:--------- ! �G: ==----#------------•--------------- Date_.. t!----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street } 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Caiifornia Lodi, California Manteca, California Tracy, California rr,-9-2m 145446 ATWOOG 12.54