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FOR OFFICE USE: -- ----- --- -------- ----------- _ APPLICATION FOR SANITATION PERMIT Permit No. 02l //�� 1�-- ------ - �!-�----�-------------------- (Complete in Duplicate) Date Issued ._------.-----------_.___________------------------ 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. This application is made in compliance with County Ordinance No 549. . MTCR • - /U / aJOB ADDRESS AN LOCATION---/� �©*Se' ®f11 ` � s;% ayS!!` n,5� - --- - -�_ - - - ` -------------- Owner's Name--- = -i 1tR H ---•------ - - ------------------------ Phone..k4qcy-_79T/----- Address._af /----/--- f c � r Contractors Name "� * - ••- - - --------------- --------------------------------------- Phonell__A.- :�..S' Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/___ Number of bedrooms _ __ Number of baths �.._ Lot size __-.- 4-_..__��-- ___________________ Water Supply: Public system ❑ Community system ❑ Private (Depth to Water Table .ice--- ft. Character of soil to a depth of 3 feet: Sand V Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----------.----------) No Ge New Construction: Yes ❑ 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 ank: Distance from nearest well----1�------Distance from foundation----/o--------Materi _____ al___ _________________________________________ No. of compartments_.___Q----------------Size-----------------------------...Liquid depth__.-k.'-----------Capacity.-,-/ !P__---- Disposal Field: Distance from nearest well---70......_Distance from foundation.../( __.-----.Distance to nearest lot line_._____...... 01- Number of lines-------�`_�_..__ ------ -----------Length of each line----7�.._________---.Width of trench-----�g_.�_ll__.__._-____..___ Type of filter material- ._--Depth of filter material--- -----------Total length-----/ 0------------------------ Seepage Pit: Distance to nearest well_____ ________________Distance from foundation....................Distance to nearest lot line-------.--_--...- ❑ Number of pits------------------ _-_Lining material----- --- ----------- Size: Diameter_----------- --------Depth---_-.-----------------------_-- 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-.---------------------------------------- IDDistance to nearest lot line--------------------------------------------------------------------.----------------------------•------------------------------------- �, p t Remodeling-and/or repairing (desc ibe):cy�=�u',', -----0--jZ- `-------------------•--------------------- ---------- L�-�/--------- ------------------------- ----------- -- ------- --------- ---- ----------------------------------------- ------------------------------------------------------------------------------------------------------- ----------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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)--- --------- --- - ------- --------------------------------------------------------------(owner and/or Contractor) By:-- -- ----- ------------------------------------------------ --------(Title)------ ----- --- (Plot plan, showi ize of lot, location of system in relation to wells, buildings, etc., can be plat o�rse side), FOR DEPARTMENT USE NLY APPLICATION ACCEPTED BY---- M -_0--------------------------------------------------------------------- DATE------ ----------------- REVIEWEDBY----- --------------------------------------------------------------- ------------------------------------------------------ DATE------------------------------------------------- BUILDINGPERMIT ISSUED----------------- -----------------------------------------------------------------------------•---. DATE---------------------------------------------------------- Alterations and/or recommendations:------------------•---------------------------------------------------------------------------- --------------------------- --------------------------------- - -------------- ------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- __1------------- --------------------------------------------------------------------------------------------------------------------------------- -------------------------- ------------------------------------------------------------------------------------------- FINAL INSPECTION BY:--- �6----- --------- _ 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