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FOR OFFICE USE: i >, ----- ------------ 40---------------- APPLICATION FOR SANITATION PERMIT Permit No. ��1.._Ffs..-� - -------------- ----- --(/---------------------------- (Complete in Duplicate) Date Issued _________._- --------------------------- IThis 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 compl7a ce with County Ordinance No. 549. MTC6 _N_ _- NRtEE .� T_N_ _ --------��-�-�_-- JOB ADDRESS AND LOCATI �__'C_1'1 �-___ c_ Owner's Name---------------•--•-- --------=--- R vv t ---- ------------------------------------ Phone---------------- ---_----------- Address...............137, ---•---•-------Address---------------13--, ........... - , ---------AIT _J ..........------------• ........ Contractor's Name__ -- Lt=- --•-•-•----•--•--------------------------------------------- --------------------------------------•---._ Phone................................... Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] OtheF ❑ Number of living units: __t_-_ Number of bedrooms _ ---Number of aths ---/--- Lot size ------,t`zlCIQ._..�-------�:...... .___._ Water Supply: Public system ❑ Community s tem ❑ Private Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand []Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date___________ ______) No � New Construction: Yes E] No ❑ FHA/VA: 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---.,5 -----Distance from foundation----I6----------Material---CON� _!__ _____--_-. No. of compartments-------.;__-------------Size_3_)(__I_� ---------Liquid depth__ e.-z-------Capacity_____ 0 _-___ Disposal Field: Distance from nearest well__-?_ -----Distance from foundation---/ -------..Distance to nearest lot,l`n�.�� _-___-_--_v Number of lines____________________._-._______-Length of each line___ ._�1_- _ ___.Width of trench.____�_��,__.___._.,.________ Type of filter mate ria I_R��-K-----Depth of filter material-------1--___-----Total length-------------/,/� _______________ Seepage Pit: Distance to nearest well----------_-----------Distance from foundation____-__--_.____-__.Distance to nearest lot line-----._____-_____ ❑ Number of pits.---------------------Lining material-------------- --------Size: Diameter-----------_------.----Depth_..--------------_-------- ----._ 4- 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________________________________._. ❑ Distance to nearest lot line---------------------- --------------------------•-------------•---•------------------------------------------------------------------ _ to Remodeling and/or repairing (describe):---------�)- P_J_04`-�_---- E= _.._._.5",TFM...------------------------------------------------------------------- ---------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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. (Signed)-- IAJ. 6/ - -- -----------------------------------------------------------------------------------------------(Owner and/or Contractor) By:-------------------------------------------------------------------------------------- --------------------------------------------(rtle)--------------------------------------------- - ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY l� --------------- - APPLICATION ACCEPTED BY---��--��--�-C--`--------------------- ------ ---------------------------------------- DATE-------- ------�------ -- REVIEWEDBY------------------------------------------------ --------------------------------------------- ----------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------- ------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations------------- -------------------------------------------------------------------••----------•--•------•---------•------•--------------------- -------•----- -----------------------------------------------•------- ------------- ---------------------------•------------=--------------------------------•-------------- ------------------------------------------•-- -------•----------------- -------------- ----------- ---------- ----------- ------- ---•----------------•-------------•------------•-------------------------------------------------------------------------•-- ------------------------------------------ ----------------- -------------------- -------------- --- --- ------------------ - - -== - --------------- ----- ---- ---- •------- FINAL INSPECTION BY:_ - - ----------- ------- Date------------- ----------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.