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FOR OFFICE US ` --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------•----------------------------- (Complete in Duplicate) IThis Permit Expires=:1 Year From Date Issued Date Issued _J __-c -r, _- Application is hereby made to the San Joaquin Local Health#District for a permit to construct and install the work herein described. I This application is made in compliarice with County Ordinance No. S49. q ¢} JOB ADDRESS AND LOCATION--- 1- � ---- -5------ -!AN�TECA--------R.�--------------------------- MTC nn�� ----------- ----------------- Owner's Name.-------�_I_f--1- N- _ ------- =- ------------------- Phone_5-23----7.2-$ Address----------- -___-- ------ ---------RAS------------ Contractor's Name----0W- -I-Vel K------------------------------------------------------------------------------------------- ----- Phone----------------------------------- Installation will serve:' Residence [ Apartment House ❑. 'Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:-IA- Number of bedrooms _ Number of baths _�.._ Lot size _44F;SA6�----------------------------- ,t � Water Supply: Public system E] Community system ❑, Private Depth to Water Table -73f-_ ft. I . Character of soil to a depth of 3 feet: Sand ®Gravel E]!' Sandy Loam ❑ Clay Loam ❑ Clay C) Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date--------------------) No .; New Construction: Yes ❑ No 2-- FHA/VA; Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS- (No se tic tank PECIFICATIONS:(Nosepticttankk or cesspool permitted if.pub.lic.sewer I'.av_ailable.within 200 feet.). Se tic nk: Distance from nearest well--- Distaince from foundation___ P -- -------.Maur al---�N�[3�-rte ------ No. of compartments--- -�-__ 3,X_ ,q __---_-Size� _X Liquid-dep kh .� .._ P y-•---c 0 -'��---- - Ca acct 7 . �---- Disposal Field: Distance from nearest well-50 Distance from •I•.oundation__JO-__-_-__-..Distance to nearest lot line_�.�____---__.- _ _ Len th of each line__ Number of lines-_______ _ _o-0-_r----------.Width of trench.....2. a :t ,,9 `''TyV'-o'f filter mat6'�ra`I_: Q__ K...__De th of filter maferial-----�_G�_____________Total length_-_ ____Di�tartce from foundation--_,._--•-�c_- -9isfance'to nearest lot line----------------- Seepage Pit: Distance to nearest well_ _____________ _ El Number ofP•its----------------------Lining mater.ial-----------..........-Size Diameter-----------------------Depth------------------------------ Cess ool: Distance from / p - riearest well_________________Distan�ee frog foundation____..____-___-- Lining material------------------------------------- ElSize; Diameter----------------- --------------------Depth---= -----------------------------------Liquicl Capacity- -- --------------------gals. Privy: Distance from nearest well______________________,.'_._. _ _Distance from nearest building------__--.-----_----._-_----------_-.--. [❑ Distance to nearest lot line------_______________ __•.._.--- . ------------ __ Remodeling and/or repairing (descrilae�__________________________ _____ __,- _._ - I i t tt=----------r------------------------- -------------------------------------------- --------------------------- n.�. �- - ; - ----•------ -------------------------------------------------------- r ---- ---------------- - ------ --------------------------------------------- ------------------------------------\----------------------------------------------------------------_---------- I hereby certify that I have prepared this a-pplication and that the work will be d'o�pa in accordance with San Joaquin County ordinances, State laws, and rules and regulations of f6 San Joaquin Local Health DisfFic X DTIL' 1SR[C # `'3`V' (Signed)______________ ! -__._.... .(Owner and/or Con-tractor) ., -------{Title)------------------------------.. . -------------------------- (Plot -- --- l (Plot plan, s=9`1ize o lot, location of sys min relation to we ls, buildings, etc., can be placed on reverse side]. i ' FOR DEPARTMENT USE ONLY # �`_ �. r APPLICATION ACCEPTED BY..... _ Q'--------------------------- ---------------_ -------------------= DATE------- _ArV REVIEWEDBY---------------------------------------- - ------ - ------------------------------------------------ DATE i BUILDING PERMIT ISSUED =---------------------------------------- - - - DATE - -------------------- Alterai61;s"a'kd/or rezommendatlans;---._.---- _ _----- - -- •• - ------------------- ------------ --------------------------------------- = °Ci- --------{----��_� -�,-,.a------- -��-;� y�,'\ l ---------- ------ --- ------------/ Il �- FINAL INS -�---- Date------------ �L.- r , 7��----------------------- ,,. SAN JOAQUIN LOCAL HEALTH 'DISTRICT 1601 E.Hazelton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street 5tocklon,CUIIifornia Lodi;California Manteca,California Tracy,California K F.P.Ca.