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FOR OFFI E: ----------------------------- ________ --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....... .`.. ........... (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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 infiance with County Ordinance No. 549. f (MTC-19 - co JOB ADDRESS AND LOCATION---------------------/`'/UST-/� 1 1� � '�' - - ----at=---&Vj----fir--- -TN�� Owner's Name----------- ----------------------------------- -------------------------------------------- Phone--------------------_--------- Address TI= ' x �',7 J-�-------- T = ----. Contractor's Name__ '1_T 19_____.? -----'----------------` 1. - --•--••---- Phone---------------------_---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j___ Number of bedrooms 3-__ Number of baths _��.___ Lot size Q_. _--__1.g7_________________-_--_ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table /V 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_16_ '2-_�__) ''No [:1 New Construction: Yes 2I�o E] FHA/VA: Yes,,�� No 1771TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well SC.__.Distance from foundation__.44:--__---_.Materi I__- 'Q .0 �__--__. n/ No. of compartments--'._.-?. —___-___Size___Xl Q_X�_,___Liquid depth__--Y �.---- Capacity...�_�'�- Disposal Field: Distance from nearest well__.�O-___Distance from foundation----/!19---------Distance to nearest lot ling_---_____ tT Number of lines___-__-__ ------ --------------Length of each line------/M.._._{�...width of trench------- Type of filter material-_R ___ _ Depth of filter material____ ��__:.-____ �'_ Total length----------------/ ______________�/+ Seepage Pit: Distance to nearest well---_-------------_----Distance from foundation--------------------Distance to nearest lot line------._----__.-_.rj ❑ Number of pits----------------------Lining material--------------- ----._.Size: Diameter------------. --------.Depth--------.------------------______ L Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- VN ❑ Size: Diameter------------------------------------Depth---•---------------------------- - ----------------Liquid Capacity_--------------------------gals. Privy: Distance from nearest well-----------------------------------------------_Distance from nearest building-----------------------------------.------ 5 ❑ Distance to nearest lot line-------- --------------------------------------------------------------------------------- _.----------------- ----------- -------------- Remodeling and/or repairing (describe):----------------------------------------- -------•-•--•---------------------------------------------------------------------------------------•-------- --------------------------------•--------------------------•-------••---------------------•----•-------------------------•-•--------------------------------------------------------------•-•-------------------------------- ----------------- -------------------------------------------------------------•-----------------------------------------------------------------•----- -------- --- --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, eStaws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ ..-----------------=---------------------------------------------- - - (Owner and/or Contractor) By:---------------------------------------------------------------------------------:nR,O---------------------------------- ----(Title)--------------------------------------- -- (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 APPLICATION ACCEPTED ------------------- ----------------------------------------------- DATE---------f17_657-_4!5- - ---------------- REVIEWEDBY--------------------------------------------- --------- -------------------------------------------------------- •-------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------- ------------------------------------------------•---------------------------- ---------- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------- -------------------- --------•-••--------------------------------------------------------- ------------------------------------------------ ---------------------------- -------------------------------- -------- ------- ---------------------- ------------------------------------------------------------------------------------•------------------------------------ - -------------------------------------------- -------- --- ----------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- -- - -------------_-------- --- -- - --------------------------------------------------------------------------------------------------------------- 44 f FINAL INSPECTIO ---- --- - ---- Date--- ---------- --------- �------------------------------ j SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. - ''Y