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FOR OFFICE USE: ---------------------- ------------------ -------------- ---------- --- ---------- --- -- APPLICATION FOR SANITATION PERMIT Permit No. -- ----- ---------------------------------------- (Complete in Duplicate) Date Issued ------------------------------------------------------ This Permit Expires I Year-From Date Issued 02-0--'2 W t. 2 Application is hereby-made to the San Joaquin Local Health Disffict for a permit to construct and in-ital(the work herein described. This application is made in cornplijance with County'Ordinance No. 549. ------Jq_Cx_T_0!qU------------------- j�B`ADDRESS-AND LOC ------F&ORTIM-E-7------ ------ Owner's Name-------•----------- AM—E-5----------MONTAWDON----------- -----------------------------I---------- Phone----•-----••-•-------------- ---- i Address hone------------------------------------ Address------------------------ ---------20,57------escal'-o/V------------------------------------------------------------------- M vetti5-----------_- Contractor's Name----WiDER-GRID-M-D........0-T-744.7L E!�----------------- Phone'....----------------------------- Installation will serve: Residence [-] Apartment House E] Commercial ��<iler Court E] Motel Ej Other ❑ RW A15P. Number of living units: -------- Number of,bed rooms -------- Number o baths -------- Lot size ------------------------ Water Supply: Public system [:] Community system ❑ Fri) epfh to Wafer Table 71- ft. Character of soil to a depth of 3 feet: Sand VGravel E] Sandy Loam E] Clay Loam 0 Clay E] Adobe C] Hardpan ❑ Previous Application Made: (If yes,date.-- __ --- No New Construction: Yes �o E] FHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No--septic=tank-or-cessool-perm'itted-if-public-sew'er-is'-avallable-wifhiti'2004ei6f.-) Septic Ta k: Distance from nearest well__/W-----Distance from fcundation-_10 .-.Material---CON CME��77EF---------- - No. of compartments-------- Size--- Liquid depth--- ....Capacity.......S---0_0. ..... pis Field: D;stance.,from,nearest.-wel�--��....Distance from fou'ndafion-----/_0.......Distance to nearest lot line---- N U m b e-7,6%.I i n e s----------- -----Length of each line---*_10-0---------------width of trench---------- -----------_4" Type of'fillfer material-_-9-Q..- .--Depth of filter rnaferiai------- ----------Total length-------------A96------------------ I �T D'sfance to near-est well___Seepage Pit: ell-__-------i_..-_-_.-Distance from foundation_----------------- Distance to nearest lot line..-----.------.-- El Number, of pits..'...._._...�_.___%.Liriing material-----------------------Size: Diameter.-._-_-_-_- -------Depth--------------------------------- ./ I L I T� , ----,Cesspool: Distance from nearest well -.-.Distance from foundation....................Lining material_..._..........._....__---..--___-.--. �. ❑ aterial....................::---------------- El Size: Diameter.-7-.-------- !Depth----------------------------------------------------Liquid Capacity-.--------------------------gals. Privy: -Distance from nearest well-----------------IN ________________________Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line-...-..--- -- -------- -I--- ---------- ----------------------- ----------------------------------------------------------------------- 40 ng (describe) Remodeling 'nlbr repairing I a . be):----------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- --------------------I-------------- ------ ------------------I-------------N---------------------------------------------------------- ------------------------ ------------------ ---- - ------ --- ----------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------- ----------------------i----------------------I-----------•- ----------I-------------- 1---------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this applicatio4n_-,iincl'thaf the work will be done in accordance with San Joaquin County � -1 ordinances,.'State laws, and rules and regulations of the'San Joaquin Local Health District. (Signed) ---- --- ---- ---- -- ---r- ------- -----------------------------(Owner and/or Contractor) ----------- ------------m------------- 4W jW, — - B ol....(__1----�_;----- --------------------------------------- - $ - ---------- (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 BY-------I-,-R,D------------------------------ -------t------'------------------------- DAT�__'_____,3__-_.;?_,r—.V14----- ----------------- REVIEWEDBY------------------------------------------------------------------------------- --- ---------------------I-----------'-------- .DATE------=----------------- ------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------- -----------------------.... DATE----------------------------------- ------------------------- Alterations and/or recommendations'-------------------------------I---------- ------------------7----------- ---------- -------- ------------ --------------------------- -•-----------------------------Z---------------------------------------------------------------------------------------------------------------- ----------1�...... -------------- •---•------------•-- ti --------------------------------------- ---------- - ---------------------- --------------------------- ------- - -------------------------------------------------------------- ------ -------------------------- ----------- ---------- ------------- -F,.___ -Y-------- ----------------------------------------------- -------------------------------------------- ............................................ ........ -- ----- - ------- ................. -------------------------r---------- ---------- --- ------------------------------------------- • -7 CY FINAL INSPECIUaN B6--u ------- --- Date---------J-_7 ------------------------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxeltan Ave. 300 Wect Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 11N - F.P,C0.