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FOR OFFICE USE: rp A / 011 ----- ----- - --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------- - ------ - --------------------------- (Comple+e-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 compliance with County Ordinance No. 549. F. H.A . 076 q(?D 40-F 3"t- `_ JOB ADDRESS AND LOCATION------------------------------ 75--•x••• E 1O-ISI 5�''---------------------�T_H.��_-�-F----•-- Owner's Name-------------I--- !!_�- -_{_. --------- ----- ---cQ--►------- --------- Phone------------..------------------ _--- �� _ �o)C.-----.3-0.�---------4-ATH__R_0�-------------------------------------- Address------------••---- --- --...----•---•----------------------------- Contractor's Name-----kA-R R/V, ----- --------------------- Phone-----• ---•----...._ ------- ------- ----------------------------------------------- ----••--------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I----- Number of bedrooms3._._ Number of baths _, —Lot size ---/k.!. _./Q.� --------------------- -- Wafer Supply: Public system [;Community system I] Private ❑ Depth to Water Table tL- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay [] Adobe❑ Hardpan p Previous Application Made: (If yes,date--------------------I No 8---New Construction: Yes 2� iso ❑ FHA/VA: Yes ?�T- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - - ,(No.septic tank or cesspool permitted if public is available within 200 feet..7) Septic nk: Distance from nearest well__,U Distance from foundation.._1_I!_---------Material -.6pnrCKETE------_-.-. No. of compartments-_-__._2--- f- Size--- _X. _Liquid depth_____ �.___ Capacity.../ZO_C___ U Disposal Pield: Distance from nearest well-.C-.vv_-Distance from foundation....)_0-.---_Distance to nearest lot/line--S-_-__---- Number of lines -------------'7 Length of each line-- _ S-> - - Width of trench--------�5P---._ Type of filter material._R_ C— _--K Depth of filter lter matena _._ �_/___.______.Total length--------- ----------------------- Seepage Seepage Pit: Distance to nearest well . - -----------------Distance from foundation------------------- Distance to nearest lot?iine----------------- ❑ Number of pits--- ------------------Lining material---------------------- Size: Diameter.----------------------Depth------j`_-------------------------- Cesspool: Distance from nearest well ----------------Distance from foundation___ ------------- ..Lining material----------------__._-----..--__-_-_ ❑ Size: Diameter--- ---------- - - ---- -----------Depth--------------------------------------------------- Liquid Capacity----------------------------gals. 11 Privy: Distance from nearest well------------------------------------_-------_..Distance from nearest building-------------------------------.___----- ❑ Distance to nearest lot line-----------------------------------------------•-------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):--------------------------------- ------------------------------------------•--•-------------•-- -------------•--•--•-•-•-------------------------------- -------------------------------•-------------------------- ------------------- - ---------------------------------•- --------•------------------------------------------ -------------------------- ------------------------- ------------------------------------ ---------------------------------------------------------------------I------------------------------------------------------------------------------------------------------------------ - ---------------------------------------- - - ------------------------------------------------...--------- - -------------------------------------------------------------------------- --------- --------- -------- ---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed), -- ------------------------ -------- --------- ------------ .-..... --------- --- -------- Owner and/or Contractor BY� -----------(Title)----------..------ ------------------------------ --------- (Plot plan, showin ize of !0 , location of system in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPA ENT USE ONLY 7 APPLICATION ACCEPTED BY -T,--t :. ---------------------------------------------- DATE----- - -^-- - ----- ------------------ REVIEWEDBY------- --------------------------- ---- - - -----_------------------- --------------------------------------------------- DATE-------- ------------------------------ -------------------- BUILDINGPERMIT ISSUED.------- -- ----------------•--- - ------- ---------------------------------------------------------- DATE-------------------------------------------------- - Alterations and/or recommendations--- -------------- --------- ------- ------------- -------------- --------------------------------------------•- ----- --------------------- I ------------ --- ---------------------------- ---------- - - ----- ----- - - - ---------- ---------------------------------------------. .--------- --------------------------------------------------------------- IF ---------- -- -------------------------------------------------- ----------------- ---------------------------•---- ----------------------•-------------------- r ---•--------•-----•-------------------- --- ---------- ---- -- ---- -- ------- ----- ----- - --- }' ---------------- - ------- ---- -- ---------- - - ---------------- -- -- - FINAL INSPEC BY _._ - Date ------------------ ------- T JOAQUIN LOCAL HEALTH DISTRICT 1601 E.lfazelfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California r E.H.9 2M 1.67 Vanguard Press