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FOR OFFICE USE: --------------------------------------------------------- / APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------- ---------- (Complete in Duplicate) Ca i . This Permit Expires 1 Year From Date Issued Date Issued _s __-a_____.__ 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- -- .. +C%} M - ,.M.w._..r JOB ADDRESS AND LOCATION TH_F�� l f,�7�------------ -------------------- `"' �' A, (AT •-_11.L Owner's Name----------1u(7-A(_rP N-Z CSV _ �5- = = --------------- ---------------- Phone----------------------------------- Address------------fir----41--/---------F--------- -------------------MTC-A- ---------- Contractor's Name------ --------------------------------------•--------------------------`--------------------- ------------•--- Phone-----------••--------•------------- i � Installation will serve: Residence �Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms -3- Number of baths Lot size..---�•J�___tC___W-Q_____________________ Water Supply: Public system El Community system=❑ Private &�epth to Water liable __ - ft. Character of soil to a depth of 3 feet: Sand ®� G"ra el'[]`Sandy Loam ❑ Clay Loarn❑ Clay ❑ Adobe ❑ Hardpan ❑ - .. i : El Application M de: (If yes,date-------.............) No,[�lew.Construction: Yes [' � No FHA/VA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: ' _ septic tank br cesspool permit+ed-if public sewer is avail able.within.20Q.feet.l4 Septic ank: Distance from nearest well___s Q-----Distance from foundation____ ------ .Mate`i I___�NC_R.1_f�T ------ th -_ __._Ca acit zQ��--- X, ,No:lof:compartments-._----------------Size---Y.x iV_X�Liquid de - -----.---- P Y Disposal Field: Distance from nearest well..S ___.._Distance from foundation_ 1_ �C Q..____-_--Distance to nearest lot li� Number of lines q Length of each line__�0-.3-0 r_;_QWidth of trench..___ ._._ Type' filter material__ Q_Cf�__.___Depth of filter material___!-1-::_- - Total length___.____.� ____________________ YP � Seepage Pit: Distance to nearest welE----------------------Distance from found ation_ -----------Distance to nearest lot line..___.__._- ❑ Number of pits----------------------Lining material----------------------Si e:.Diameter.------ ------------Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from founda�n�------------------Lining material-------------------------------------- 0 Si _._._.-.-_-_.______----- __-_____.❑ I Diameter Depth �_ ------" '-"`.Liquid Capacity------------------ ---------gals. Distance from nearest wel--------------------------------Privy ____f_Distanco from nearest b ilding____._____.__________________- --------. - [] Distance to nearest-lot line_---____ ------------------- ---------------- ---------------- S-!3-(ata. Remodeling and/or repairing (descgbe)_----__ ____ _ _ __ ---- - ---- OJ -------------------------------------------------------------- ----------0_F------F1IVA Jnr P_ r�prv-------------- 1------ --------------------_----------------------------------------________________________ _ __-___________________. _ J___ T____ .__._-_____.____._______________________________..___ ----------------------------------------_---------------_----�_-__________________________________-_____________ _________________________________________-_---- _____.____•_______________._..__..________.___.__.._.__._._ I hereby er+ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, and r nib r tions of the San Joaquin Local Health District, (Signed - - - �----- -------------------- ---------- -=------------------------------ (Owner Oa orContrac Contractor) i -3 tion of system In relation to wells, buil BY: �'_ -= = :: R-��={Title{--------------- ----------------------------------------------- - P (Plot plan, showing size of lot, Iota y dings, etc., can be placed onsreverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------�f_R__0--•--------------------- ---------------------------------------- DATE------ -- - --- �t REVIEWEDBY-------------------------- ------------------------------------------------------ ----------------------------- ------.- DATE----------------- ---------------------------•------------ BUILDINGPERMIT ISSUED------------- ------------------------------------------------------------------------------ --------- DATE----------------- ----------------------------------------- Alterations and/or recommendations:---------------- ------- ------------ --------- 4- �`-----'=--------------• -- ---------------------------- . C - --p� - r -tit --------•------------- -- ----------------------------- ------- --------------------- ----------------------------------- -.......... - -------- - -------- - = - -------- ---------- - ----------- -- ---- -----•--. FINAL INSPECTIO Y: Date.... - ----- �_`� ....� ..------------- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasallon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.C9.