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FOR OFFICE USE.4 APPLICATION FOR SANITATION PERMIT Permit No. ---- ---------------------------- - -------------------------- ------------------------ (Complete in Duplicate) - Date Issued ----------------------------------- This Permit Expires 1 Year From 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 c mpliance with County Ordinance No. 41, _1I 11 c# 5'I DF M. JOB ADDRESS AND OCATION Dv ,�, 1�L1'7T -- ' Owner's Name---------jof-)A--------�- , ------------------------------------------- ---------- -------------- --- Phone------------------------------------ Address---------------F-0-'------�.�__'Q ----------------W-1- M:TC14----`--- -------------------------------___------.-.------------------------------••-•--- Contractor's Name--MAAl �---` _ Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Traile 'Court El Motel E] Other E] Number of living units: -j---- Number of bedrooms __ _ _ Number of.baths Lot size -_. -_________--..--._ Water Supply: Public system ❑ Community system ❑ Private FT-"Depth to Water Table[S_ ft. Character of soil to a depth of 3 feet:� Sand [Gravel ❑ Sandy Loam❑ Clay Loam E] Clay E] Adobe E] Hardpan ❑ Previous Application_ Mede:T(If yes;da#e__..___� Noi2o" New Construction: Yes�Z�, lo ❑ 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 f tom nearest well-------------1__-Distance from� foundation----_--_---- ---_Material--_-:------- &—No. of compartments----------------------�---Size---------------•---------------Liquid depth----------- -------------Capacity----------------------- I 1 Disposal Field: Distance from nearest well.--6;. ---L Distance,.from-foundation--- ------- Distance to nearest lot ;•3 -F --_---- i^X 1 Af6- Numljer of -lines------. ----- ----------- - --Length of each � Width of trench-.---- - -- -----e----------- ---- Type TYpe}of filter mate6al__�0� `-_-,_ --_Depth of filter-material--- Total length---------------„5-C--__----_-_-_---V1 Seepage Pit: Distance"to nearest well------------------?...Distance from foundation----------------------Distance fo nearest lot line----------------- ❑ NumSer of pits----------------------Lining material------.-- Size: Diameter---------.------------Depth--------------------- I Cesspool: Distance from nearest well..- _Distance from foundation.............!--- _Lining material-__ n___-_-.------_.._._-_----.--_-_- r ❑ Size: Diameter------------------ -- ------- ---1 Depth--------------------------------------------- ----Liquid Capacity------.--------------------gals. Privy: Dista Ice from nearest well----___------_-----_-----------------------------Distance from nearest building--------------.------------------------ ❑ Distance to nearest lot line-------------- �— � '"�'^'� Remodeling and/or repairing (describe):--------------------------------------------------------------------------- -----------•-------------------------------------------------------• fi► I r --••-•------------------------------------ - --- - ------- - - ----•---------------- ------ ---------------------------------------------------- ---- - ---- --- - -------------------------------- t-55- - ---------------------------------------------------------------- ------------------------------------------------------------------------------ 1 r._ ---------------------------------------- - __._..-c.________._______________-_____._______.____._.______________.__.____._____________________._______-_________-_-._-_-_-_-.___-_.-____.________._-_-___________...-... 1 hereby ce#ify thatil,have-prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to la ,'and regulat'ons of the San Joaquin Local Health District. J Si ned _ —�-�' ____.______ __.....Owner and/or Contractor) z (Signed)____g 1___ { 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 --- DATE- -- JrL 'zf.... APPLICATION ACCEPTED BY ' Ca -•-------------- REVIEWEDBY--------------------------------------------------------------------------------- ---- -------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DA-TE------------------------------------------------------------- Alterations and/or recommendations----------- -- --- -- - - ---- --- ----------------------•--------------------------- --------•-•-----•-----------------------•------------------------- ------------------------------------------- -----------------------I----------------- --------- - --------------------------------•---------------------------------------------------------------------------------------- --------------------------------•----------------------------•-------------------------------------------------------------------------------------------------------------------- ---------------------------------------- FINAL INSPECT] . BY ; Date. . - ---------------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.R0O.