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1-UK,-UNIC:E USE: ------------------- ------------------------------- ------- ------- ------------------------ ---------------- ------------------------------_______________________________________________.________ APPLICATION FOR SANITATION PERMIT Permit No. ----------------- ----------- ---------- *{Complete in Duplicate) d ' 3� ------ ------- --- This permit Expires ] 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 qade in compliance with County Ordinance No. 549. MTCA4 JOB ADDRESS AND LOCATION-•-- -CH-----&911 n-------1-ga• W. I - Owner's Name------ tQ �" � Phone Address ` �`ar ... Q�11�_�Vl_I�.YI� 71�i I`Q = - -------•- ------------------------ Contractor's Name---M_TX_-A `a-• 7- ) o- -------------------- ,----------- Phone.-------•------------------------- Installation will serve: Residence E' Apartment House f❑_Vtommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I____ Number of bedrooms Number of baths -2- Lot size ---1499 Water Supply: Public system ❑ Community system,❑ ,Private'e'Depth to Water Table Aa ft. Character of soil to a depth of 3 feet: Sand Gravel ❑" Sandy Loam ❑.�L lay Loam E] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------------._) No i�r New Construction: Yes M"'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______ _ Distan.reVr`oln)fot ndation----/.0----.___.MateriaL_____.__'_��_ No. of compartments---------- ------------Size_"_ 7124-X _Liquid depth---- .----.-C apacityrr °C -_TiR,o, Disposal Field: Distance from nearest well__- -- ____Distance from foundation___/ _: ____.Distance to nearest-16f Number of lines--- Length of each line r __ '.Width of trench--------- Type of filter materiaL__8__Q_+�,(<,-Depth of filter materia_____�_��.___. __._Total length----s.----,��-- -_-_�s3} ---_.Jr T,R.'a- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line________________--- ❑ Number of pits----------------------Lining material---------- ------------Size: Diameter--.--------------------bepth__-_.------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material''_____--- _ __.___.______________- ❑ Size: Diameter-=;10-------------------------------Depth----------------------------------------------------Liquid Capacity-------- -------------------gals. Privy: Distance from nearest well____________ _____________________.________.-__-Distance from nearest bui{ding_----,.--- __-_._____________..___..__. ❑ Distance to nearest lot line - ----------- -------------- Remodeling and/or repairing (describe):___. �_- ]7- 27, -------------------------------------- `~ -•-------------------------------------------------------------=---------------------------------------------------------------------------------------- -- --------------------------------- ,- --------------------------------•--------------------------------- -------- = tlA ! 'y 11 - ----•------------------- -------------------------------------------�--�--- -------------------------------•--------------------=-------------------------------------- ----- ro . - .., .- 1:--------------- ---- ----- 1 Thereby certify that I havelprepared this application and'that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules and r'gulations of the San Joaquin Local Health District. (Signed)_________ -------------------------------------------------- (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). FOR DEPARTMENT USE ONLY IF r-. APPLICATION ACCEPTED BY_----i-F--0------ --------------------------------------•----------------------- DATE--------_3------117= 4< 3 REVIEWEDBY----------------------------------- --------------------------- ------------------------------------------------•------- DATE--- BUILDING PERMIT ISSUED - ---------------------------------------- DATE Alterations and/or recommendations: ----------------------------------•---------------------•--------------------- --------------------------------- ------------------••---------- ------------------ •-----/- / - - - ----- --- ----- - - ----------------------------------------------'--------------------•--------------------------- ------------ ------------------------- _____- __ _ _ _._____. __-____ _ .____--___.______.'.S__________.__._____._.. FINAL INSPECTION --------------------- --- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton 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 'dM 3-'63 t-.P.CO.