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FOR OFFICE USE: 4 ------------------------------------________----------- --------- __ --- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------ -- ---- ------------------- (Complete in Duplicate) Date issued ---40_fI ----------------------------- ---- ---- --------..---..--- This Permit Expires 1 Year From Date Issued :2ce— 1q6_04 Application is hereby made to the San Joaquin Local Health.District for a permit to construct and install the work herein desc ed. This application is made in pI' n .with County Ordinance No. 549. ! MTC r+ n_-.-_. ' JOB ADDRESS AND LO TION- _��_r.I)a:--- P�.1H-----1_.l_ -E:-------'_'Z.da------uV-_---�J�.-----��T��-�--�--- Owner's Name ------- �_M-� --------- l0- R-[_Y ' ' ' - " Phone Address............... Contractor's Name-----------ir—uLLE�-----•--- t ---- ------ Phone-----•••----------•---••--- Installation will serve: Residence El- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 Number of living units: ) -_____ Number of bedrooms _-_ Number of baths _ .- __ Lot size ___A6a__X___� � �- /Ott--X- 7_�o_Q----'--'-'------------ Water Supply: Public system.❑ Community system ❑ Private Depth to Water-Table -9- ft. Character of soil to a depth.of 3 feet: Sand Gravel ❑ Sandy:Loam ❑ Clay Loam E❑ Clay ❑ Adobe ❑ Hardpan ❑ l Previous,Application .Made: (If yes,date-.'.-._-�_'__`_.-:)`No J5-- New Construction: Yes Er'N o ❑ FHA/VA: Yes ❑ No,Er TYPE OF INSTALLATION`AND SPECIFICATIONS: + x (No septic tank or-cesspool permitted if public sewer is'available within 200 feet.) t Septic" k: .Distance from nearest welL__,_0______Distance from foundation_1,;)------------Materrai__CiR_ _ --------- No. of compartments--------- ---------Size--- X�a_X- Liquid depth_{ Capacity-_-� C�_-- Disposal Field:` Distance from nearest well .S_0 :'Distance from foundation---/6)---------Distance to nearest lot line___ ________- ati Number of lines_____ __� __. _-.- Length of each line---[ ? =____ 'Width of french__.___36_ `` ` �' - V Type of filter material___ {. ___Depth of filter materal_ 9`__._-t:_Totai length....... ________________._ Seepage•'Pit: Distance to nearest well'-----------------------Distance from foundation---------------------Disfance to nearest lot line------------------ El _,-_____.__-.__❑ Number of pits.............----------Lining material.---- ----------Size: Diameter-----------------------Depth----------_--------------------- � 'Cesspool: Distance from nearest well-----------------Distance from foundation-------__--------_Lining material-----------'-------------------------- ❑ Size: Diameter .---------------------------------Depth--------------------r------------------- --------Liquid Capacity----------------------------gals. _ Privy: Distance from nearest well_____ ______________________________Distance from nearest building ❑ ,6 g I Distance to nearest lot line----------------------- -------------------- ----------------- Remodeling ---------------Remodeling and/or repairing (describe= _ - ----------•-------------'--------------------------------------------------------------- -------------------------- ------ ---------------------------------- {. --------------- ----------- - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I iiwe prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,-anJ rules and reguiafions of the San Joaquin Local Health District. (Signed)---- ----- —/------------------ -- ---------------------------•--------------------------------------------------)Owner and/or Contractor) By: ' a --- - --- '--------- -------------------------- ii a --'------ ---------------------- --- -..... ---..-'-- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i A FOR DEPARTMENT USE ONLY -. APPLICATION ACCEPTED Y R Q' ------------------------------------ --- - -- ----------- DATE_-. l--- r C.,S—_------ ------ REVIEWED, BY -------1 - -- - ------------- -- ------- - ----------------------------- DATE-- ---------------------------- BUILDING ----- ------- --BUILDING PERMIT ISSUED- --------------- -Y------- -1-.--1r-:--— - - ----' =----------------- DATE-------------------------- ' ' Alterations and/or recommendations:_-__- _--.-.-:_ -- - --- _.-__-____.._____________________________________ - .-- M : FINAL INSPECTION BY:- � -- -- -- -- 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 # F.P.CO. wb 9p