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I-UKUl-l-K-t USt: --------------------------------------------------------- lf ------ ------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------•------------------------------------------- (Complete in Duplicate) ------------------------------------------------ -------- This Permit Expires i 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 c7liance with County Ordinance No. 549, J9NTEC11 JOB ADDRESS AND LOCATIONr . ---E----.�F-----�1_R-t�dR Owner's Name =- �•� Z------- Int T------- ----------- Phone.---------- Address Tom._"` ® �.� ---------M-;I N`T—C .. - ------------------------------ Contractor,s Name--------OWAL—_K.-------- I-- --•-- Phone---------------------------------- Installation will serve:, Residence U2r"Apartment House ❑ Commercial'❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: j.... Number of bedrooms__- Number of baths _/__ Lot size -_ ~. Water Supply: Public system ❑ Communitysystem y stem ❑ Private [Depth to Water Table ._ ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay� •�,,� � _❑ Y ❑ Y ❑ y ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) " Noew Construcfiion: Yes U5, ❑ 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-5 Distan4e from foundation___ __ ____ �_--_ - - > t T! f� Myttr:aQE/l/Q-O- --- ��( No. of com artments_ -- ------------Size- fp �� -X_ quld depth --_-----Capacity•%._ Disposal Field: Distance from nearest well_50-__.._Distance from foundation----/0-------Distance to riearesf lot line-___� Z ' "� g , 1 Number of lines_________ _______ _ ____________ Lin th of each line___.______ 3____`_`__.Width of trench________ Type of filter material____ Ul-It'-N----Depth of filter material___- _._ __��____Total length_______ -------- 5eep�g� Pit; Distance to nearest well------.._____________Distance from fol:ndation'__________-Y Distance to nearest lot line_________________ 7 Number of pits----------------------Lining material-----------------------Size. Diameter-----------------------Depth---------------------------- Cesspool: Distance from nearest well_________________Distance from fount ation-------------------Lining material--------------------__ _ ._ - - ----------- El Size: Diameter------------------------------ ------Depth----------------------------------------------------Liquid Capacity----------------------------galr'o Privy: Distance from nearest well_____________________________________ _______Distance from'nearest building ❑ Distance to nearest lot li e______________ ---------------------------------•-------------------------------- -------- 3•-29- r rr Remodeling and/or repairing (describe):------- ----------- + `7 _ N1-4------- �-•------70---- --------- fNl-r� ---- iLLic� PTI-F 1�_ 7�t�vi4rv_ sfi!OLID- �' ��----------56n5_I= ------ -- if c l l s rvt _rJ ._ --------- 1 - -----f �' ' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County o� ordinance State laws, and rules and regulations of the San Joaquin Local Health District W!TN - -FH r S 5 S-T�N1 /+S (Signed) - � �/"= --------------------------------------!S SR tSr�lac-i y ---� -- -- - - - --,--- --- - -------------------------- Owner andla 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 APPLICATION ACCEPTED BY1.R`Q-` --------------------------------------------- - f - DATE-------------- --- ---------REVIEWED BY--------------------------------------- ----- ------------------- ------------- ----------------------------------------- DATE------------------f DIN PERMIT ISSUED-------------------------- ---------------------- _--------------------.----------------------------- DATE--------------- Alterations and/or recommendations:.__-__ ---- ____v___ ___.... 0�_____ ---•-------------•-------------------------------------- ------------- ----------------•-------- --------------�---------------�X!s_ri nct .. R ---- -------8a: - :--------------•---------------------•--------------------- --- ----------------------------------- -- ----------- ------------------------------------------------ -------------- --------- ------------------------------------------------------- - n FINAL INSPECT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street ♦ 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California "Manteca,California - Tracy,California ES 9 REVISED 8-$4 3M 3•163 F.p.CB. s