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APPLICATION FOR SANITATION PERMIT Permit No. (Completein'Duplicate) ' Date Issued -L_-=/j_-�_�17 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. JOB ADDRESS AND LOCATION -Rk'I Pct" 'VG SYS. Owner's Name------------ - one- F ------ Ph .-; _,%j- -------- Address ai �f �^��"��. �^-�----------------------=---- Contractor's Name f--------------------------------------------------------------------------------------------- Phone------ --------•-- •------- Installation will serve- Residence Apartment House Commercial ❑ Trader Court ❑ Motel.,.0 Other ❑ Number of living units: Number of bedrooms,_-- Number of baths )-/ Lot size ------j_#--- -----------------------_---_ } Water Supply: Public system"5k Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ w Clay ❑ Adobe Hardpan Previous Application Made: Yes ❑ N0�6_ New Construction: Yes No ❑: FNA/VA:�Yes ❑ No`2'k T TYPE OF INSTALLATION AND SPECIFICATIONS: ' - ~+ 1 (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) r— I -------'.Material----F414te! Septic.Tank: Distance from nearest well'.-44 ----_Qistance from fou�ndation-_. ---� _ __'--__ - r No. of compartments = Size-2 x ?-----Liquid depth-- --'V----------------Capacity-----qCo------ Disposal Field: Distance from nearest we1I_'-S G_______Distance from foundation:-._O_-_,------.Distance to nearest lot line-.-,,., Number of lines-----_ ---- --------------------Length of-each line-----` ' ---------------- .Width of trench.--'- r-��----�----------- fN Type of filter material--�Ct±/---_----__Depth of filter materia-�.-.�-�_____--Total length__-_-----�_r_------% � ?--- Seepage Pit: Distance to nearest well________________----_Distance from foundation__�._________-___-.Distance to nearest lot line--.------_-___- r, � ❑ Number of pits----------------------Lining material------------------------Size:•-Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well---------------_Distance from4foundatior�--------------------Lining material---___------------------__.----_---_. ❑ size: Diameter-------------•- -----------Depth---------------- ----------- :------------------Liquid Capacity---------------------------gals. i Privy: Distance from nearest� well------------------------------------------------Distance from nearest building------------------------------------------- �,� ❑ Distance fo nearest lot line------- ------------------------------------ ------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe):-------------------------------------------------------------------------•---------------------------------------------------------------------•-------- -------------------•-------•--------------- Jf j ---------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, and ) rule and regulations of the San Joaquin Local Health District. (Signed ... _. --------------------------------------- ----------------------------------------- ________________Owner and/or Contractor i By------------------------------------------- --------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot plan. showing size of lot, location df system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------- ------------------------------------- - DATE-------- `J d -- ------ -- -------------------- REVIEWED BY DATE = ------------------- BUILDING PERMIT ISSUED---------------d------ ----------------------------------------------------------------------------- DATE - Alterations and/or recommendations:-------=-------------------------- ----------------------------------- ------------------------------------------------ � e ------------ r -r_ - _� � = rUjA,___ - - Z"_ ,.. _��,p , ,� �• ,--ter � C� �- �� -- -------- -- ------ r - - ------------------------------- �- `) . rk-'" "'Y ; t _ �� �. :7- k F fNAJ SPkt—T-41O . . ----------- Date------- t- AN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised 1.57 F.P.CO. _