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.-OR OFFICE USE: ---- --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . _ __. ._. Z-- -------------------------- ----------------------- a� This Permit Expires 1 Year uFrom eDate 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 a lication is made in compliance with County Ordinance No. 549. MTC JOB ADDRE AND LOCATION---- PEA1C1 I----------3---------- !__�f4 Cid � "EA _� Owner's Name '�-�-R{`-�------- ------------------------ -- ---- Phone.-----------•--•------------- ------------------ -- - - ------ Address-------------------------f-------/Z57------ X}PL -------_5 r 41-T.- .-----------------------------------------------------------... Contractor's Name-- � T C �`J � C-------- -F'R.\ _cs -----•-----------------------'----------- Phone--------••------------------------- Installation will serve: Residence 0- Apartment House Commercial ❑ Trailer-Court ❑ ..Motel ❑ 10ther ❑ Number of living units: --.I---- Number of bedrooms_ _Number f baths" ' Lot size ____./!p. _- x__ -------------------- Water Supply: Public system ❑ Community system ❑ Private VDepth to`Watei Table .9-- ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam L] Clay#Loam ❑ Clay ❑ Adobe ❑ Hardpan [] Previous Application Made: (If yes,date--------------------) No [J�New Construction : Yes R-'Iqo ❑ FHA/VA: Yes ffj'� No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o..,I I septc tank sspool permitted it.. psewerublic ceilable within 200 fe;Dt.)_ M~ -------- - PR E FF-es Septic TankDistance frroti mneaeswell 70. Distance ---Z --._._-.Matria RT� 0---_-__-_-.______.- E No. of compartments_rt .�Z .-.--..----5ize_3_uxLi uid depth---_. --------- ---------Capauty.... Disposal Field: Distance from nearest well---J� ------Distance from foundation'___ .... Distance to nearest 16tS_�_---- [� Number of lines-_____---�........--_�.--Length of each line__' y_ _ Q.__.Width oftrench-----31a_!'__ Type of filter material.._ i GK_-Depth of filter material----.f t.`_..._--Total length__._._f� _____---------________ Seepage Pit: Distance to nearest well----------------------Distance from foundation----�4---------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--__. -------------------------'--i---._---Distance.from nearest building-- '--_------_------__.____---------.-- ❑ Distance to nearest lot,line--------------- ---------------- ---------- -----------••-_----------- ------------- ------------ '�------------ - ------------ - 1� .� ,; . ,, , F- X A 1-11-1Cr NJ, � «: Remodeling and/or repairing (describe)---------- - --------------------------- ---=1 - -:, � t -•1---•---- =-••- -----------------•--•--------------te a ; �.., ta Ir r 1 �. ---------------------------------------------------------------------------------------------------------------------------------•------------------ --------------------------------------------------------------- --- -- - I hereby certify that I have pre par. this application and that the work will be done in accordance with San Joaquin County ordinances, Stat e aws and rules--and h gula ons of +he'San Joaquin•Local Health Dis+rict: r `prep/ 5i ned------ / :. g )-_-;� ..G�_-- �.�<--`=s✓=`------- --'� ��' ..- ---(Owner and/or Contractor) By:-----------------------------------•-------•---------------------------------------------------------------------------------------(Title)---------------------------------------- --- - - --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side).'- p FOR DEPARTMENT USE ONLY APPLICATION'ACCEPTED BY-------- �1=G� '--------------------------------------------------------------- DATE--------- --- 2:' ;- -Z- ---------------- REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------- DATE-----------------------•----------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ ------.- DATE------------------------------------------------------------- Alterationsand/or recommendations---------------------------- - -------- --------------------------------------------•----------..-•------ ------a---------------•--------------------------- .. ------------------ -------------------•-----------------•-------------------------•----------------•--------------------------------------------------------------------- ------------------------------------------------•--- 0. i ,r FINAL INSPECTION�B - ------ ---- --- Date---------�.._= �LX--------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Ifazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'S3 F.P.CO.