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FUK VFFRA ubt: 1 ----------------- - --------------------------------- _--_.. APPLICATION FOR SANITATION PERMIT Permit No. -------- ----------------------------------------------- (Complete in Duplicate) ._____._______________________________________._..__..__ This Permit Expires 1 Year From Date Issued Date Issued k Application is hereby made to the San Joaquin Local Health District for 5 permit to construct and install the work herein described. j it This application is made in comp'ance with County Ordinance No. 549. Pp ri k/ 2 ��AA / JOB ADDRESS.AND LOCA ONrD� SEAA ," �''''�`t Ill) p� C ------- A ------ I Owner's Name----------- MPR_!_SL=_S- --------------------------------------- Phone------------------------------------- :Z --------•---------•------ -- ------- ` �Add ' I Q . --------- ress Contractor's Name-----17 N Z-----•-------------------------------------------------------------------------------------------------------- Phone---------------------------------- installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ bUPL•F k 1 Number'of living units: Number of bedrooms __ Number of baths -_ Lot size ____.-IC_ E_f}C :_________-_._-.___ Water Supply: Public system El .Community system El Private Depth to Water Table Zztt. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sa dy Loam E] Clay Loam ❑ . Clay E] Adobe[:] Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes to ❑ -FHA/VA: Yes �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: y[No septic-tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_.. �� ____Distance from foundation ./_Q_ -.Mater•al eo C_R.i----T �"` No. of compartments____ ----------Size_S_e� _f4?..k_-6___Liquid —_-__.__Capacity__/6O_��____.___ I Disposal Field: Distance from nearest well____5_rJ._.Distance from foundation----/.Q_.__._.-Distance to nearest lot line---- Number of lines--------� _------- -----Length of each line------�Q©-.--�;-.-.Width of trench.-----'�_._1/-11--- ------ Type of filter material__= �.C�S__Depth of filter material__._.1c7_---_:__._Total length-----------2--Q0__________________ ' Seepage Pit: Distance-to nearest well _____-----------_____Distance from foundation....................Distance to nearest lot line-.__-_x____-___: i ❑ Nurriber 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.____._-_-.--_-----_---_---_--.__-_-._-__ ❑ Distance to nearest lot line--------------------------- -------•--------------------_------------------------------------------ ----- --- I i- Remodeling and/or repairing (describe):-------------------------------------------------------------------------- -------------------------------------------------------------- -- -. I& I ----------------- ------------------------------------------------------------------------•----------•----------------------------------------------------------------------------- - _ _ a, ------ --f-�ereb rtif' that I havQ---re prepared this and tha---------------------------------------------•---------------------------•- --------- •- - y y p p pp t the work will be done in accordance with San Joaquin County ordinances, at laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----- - - �^ - (Owner and/or Contractor) 13 _ Title "qt Y Asizeof :W: ie)—-,_-.-- ---�-- --- —_- - -Y_ —_:Plot plan, showint,.location of system in relation to wells, buildings, etc., can be placed on reverse sido). FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY.---------�l- ----------------------------------- ---=-- DATE--------1-717-77� -------- REVIEWEDBY---------------------------------------- ---------- -------------------------------------------- --- -= =----- DATE------ -------------------- --•- - ` BUILDING PERMIT ISSUED-------------------------------------- -------------------------------- ........ ..... ---------------- DATE-------------=---------------------------------------------- Alterations.and/or recommendations:____________________ --------------------------- ----------- --------- ----- •- ------------ -----------------------•--------------------------------------------- --- ------------- -------------------------------------------- - -------------------------- ---- - ----------------------------------- ------------ _ �.. � ----- - --- --- -- ----- ---- -- ---------- ..t---- " FINALI N - ---- ---------- - Date---------------- --- ........... - .................................. a SAN JOAQUIN LOCAL HEALTH DISTRICT 'i•1:b01;E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street;; . 205 West 9Th Street Stockton,CaliforniaA Lodi,California } Manteca,California Tracy,California ,� F.a.cn. s