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.FOR OFFICE USE: F T --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. - --------------------------------------------- ------ - [Complefe.,in.Duplicatel -- Date issued /__��_�l-_�✓� ---_-__________----------------------------------------_ This Permit Expires 1 Year From Date Issued 4' , Application is hereby made to the San aqu n Local Health District for a permit to construct and instak-the work herein described. This ap@l � o is m in o pliancCounty Ordinance.No `549' � , fVI CA /J f JOB ADDRESS AND LOCATION_5I_ F�i .77LC /f� '1L' P '" ~ Owner's Name------------------F--RJF--D-1 -RE:J_N_ Phone ----------------------- Address-------------------- ....... - -------------9__ ............. R----_---Contractor's Name _ _+ : ------------------------------------------------ ------ Phone-.----- ----- t Installation will serve: Residence ❑ .Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____I__ Number of bedrooms _3__ Number of baths -------- Lot size ------A:C13_G_--------------------------------- Water Supply: Public system ❑ Community system ❑ Private ❑Depth to Water Table _ �-� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Q Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Ilf yes,clate-- .__...__,______-) No New Construction: Yes ❑ No © FNA/VA: Yes ❑ No ©' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted'if public'seweiris-available within 2001eet:)' Septic Tank: Distance from neare' st;well----4 __D-_-Distance zfrom foundation___-16____._.Mjerial-____R _PVVCp/)> ---------- L `_7'_ _-�]___Liquid de th__ - _--------- Ce acity--- 2 r No,,of compartments-------L -------------Sie__, _ Disposal Field: Distance from nearest well-'� Q___Distance from foundation_7/0-------.Distance to nearest Lomat Number of lines------------I----------------- ---Length of each aline__='_+f/_e-)-- --- Width of trench........ ` . Type of filtermaterial---R0_C_K-_De Depth of filtervmate,rial___ _. _ ..__.Total length.-le" ._.__lht9____________________ y' - P I \ Seepage Pit: Distance to nearest welt__________________-__Distance from foundation--------------------Distance to nearest lot line-------.--------- ❑ Number of pits----_..._.'_...!w_ Lining material--------_-.----7-----Size: Diameter--------------------Depth----------------------------- Cesspool: Distance from nearest well°"'"'"______.__Distance from foundation._.___.___.____.Lining material_ _________________________ ❑ Size: Diameter------- -------------' ; Depth �-=------------------------- - -----------i----Liquid Capacity---------------------------gals. ! - t �.r ` Privy: Distance from nearest wellL-- -----------------------------------Distance from nearest bui4ding_---'_------------------------------------ ❑ Distance to nearest lot line------ ---- = _ Remodeling and/or repairing (describe:---49 A .___�:._ -+ �-•----•-------- � 1.20�__' ----------------------------------------------------------------------------------------- --------------------------------------------------------------f-�r---r_o)_Com. S�67`>=n_?---------------�------------------------------------- N -------------- ---------------P% ------- ---P%--- --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stale laws, and rules,#nd regulations of t e San Joaquin Local Health District. (Signed) --'`----''--- --- --------------------Owner and/or Contractor . .. r . .:- - .. -[Title) - � - By --------------------- = _ : .. .,,, — = = ------ (Plot(Plot plan, showing size of lot, location of'systemrinrelation to wells, buildings, etc., can be placed on reverse'side. �k A FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -------------------------------------------------------------- - DATE----- '�� -_ -------------------- REVIEWED BY `=" ' ' ' Ei � ------------------------- € '. DATE-- BUILDINGPERMIT ISSU.ED----------------------------------------------------------------------------------- ---------------- DATE---------------------------tf------------------------------ Alterations and/or recommendations:--_________________ - .-1 1. ------------ ----------------------------------__0---------------------------- ------------------ ----------------- -------------------------------------------------------------------------------------- ---------------------------- ----------------------------------------- -------------/- - -------- '------------------------------------------1-1----------------------------------------- -------- ----------------- ` . / ----- ------- } - FINAL INSPECTION—BY:: _- � --------- --- Date--------- ------------------------ . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. v300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracy,California