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FOR OFFICE USE: .................................. ...................._ APPLICATION FOR SANITATION PERMIT Permit No. -------------------- ---- -----------------I------------ (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 in compliance with County Ordinance No. 549. MT-crl JOB ADDREJ ANDL ATI S ` --------.. R. oTT -...... Owner's Name-------------- D-14-6------S-0—y-DER------------------------------------ Address---------------------- T.--`4-----------B Qx---------, LP a-A----------.....-MT Contractor's Name-------- � ------5RPT.C..------ _ ._C-------------------------------------- --------- Phone---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: __j--- Number of bedrooms 3--- Number of baths _AZ__ Lot size ---ACR 14A ------------------------ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table 1s_ ft. Character of soil to a depth of 3 fee+: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date.------------- --.--) No �ew Construction: Yes �o ❑ FHA/VA: Yes [�t' 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--5-0-----Distance from foundation---1-_--_-----Material- - -_ [� No. of compartments-...___Z------------Size_-_�fXID A%57-.Liquid depth--.-- Z-------Capacity___//-0-0 _ l Disposal Field: Distance from nearest well---- .-_Distance from foundation__10_.----_-_.Distance to nearest lot ling-_t _____ 4• Number of lines_--,._____z- __.----_-Length of each line-S __1t �0_._.Width of trench:_-_-w _ "j Type of filter material-_JR0_C/�____Depth of filter material--___J - - -----Total length-------------------;E74b----------- tA 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-,.--------------------------------------- F1 Distance to nearest lot line- ----- --------------------------- ---------------------------- Remodelingand/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, State laws, and rules and re- g ions/oft the San Joa yin Local Health District. 0 [Signed)..____L_ --------- ----------------------- --------- - ------------------------(Owner and/or Contractor) By:-------- - At-----�',E-PT►C__'TA VK5t------ ---------------------------------------------(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 BY-------7E.R�-Q '--------------------------------------------------------------------- DATE-------- =� - •� . REVIEWEDBY---------------------------------------- ---- - --------------------------------------------------------- -------------------- DATE BUILDINGPERMIT ISSUED--------------------------------- ------------------------------------- ----------------------------- DATE---------------------------- Alterafionsand/or recommendations----------------------- -------------------------------------------------------------------------------------------------------------------------------------- ------------------------- --------------- -------------------------------------------- ---- ----------------------------------------------------------------------------------------------------- ------------------- P--- --- ----------------------------------------------------------------------------------------------------------------- FINAL INSPECTIO Y. '1114 Date--------------- 1 • ------------------ 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 r.P,c o. i --