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F0RAjfFICMSE7 - ----------------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------- --------- --- -------------- (Complete in Duplicate) -- --------------- --------- --- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Heal}h District for a permit to construct and install the work herein described. This application is made ' compliance with County Ordinance No. 549. R I� �� JOB ADDRESS AND LOCATION-- R-F- �,H--- ------kt�-----/r1,0----,1,,,.1. � • _ - -------•------- ----A�.U.t; _��-------�>_.------ Owner's Name------------: �� - - _ e �--z- _ Phone ------------------------ Address-----•--------------- Contractor's --•-• ---------Contractor's Name--- --O-WAI- - --------------------------- - -------------- Phone.----------------------... Installation will serve: Residence;©—Apartment House ❑ . Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ { Number of living units: ---I--- Number of bedrooms ____ Number of baths __2-_ Lot size _.9-C - Water Supply: Public system ❑ Community s tem E] Private Er-'-Depth to Water Table ;� ft. Character of soil to a depth of 3 feet: Sand Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---_________________) No Ej�- New.Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No TYPE-OF`INSTAL-L'ATION AND`SPECIFiCATIONS z (No septic tank or cesspool permitted if public sewer is available within 200 feet.) h j Septic Tank: Distance from nearest well----5- ___Distance from foundation______) -------Material---- N - T _ No. of compartments-------- --- ---------Size---/--X_1(2.*-5____Liquid depth__.___/ -- -_ Capacity ZOO? / P Y--- ----- ------ Disposal Field: Distance from nearest well--- - :---__Distance from foundation----/-�__-.__-__ ' r Distance to nearest lot lin _ _________ rr ® Number of lines------------- --------------•------Length of each line-------/07------�_------Width of trench-------- (�-------�------- Type of filter material-__-i-1®_.C—K___Depth of filter material-----P7......._--- otal length----------/co--------------------- Seepage - _- --------- Seepage Pit: Distance to nearest well------------------.__.Distance from foundation__'_________________Distance to nearest lot'line-----------.__ l�. __- i r umber of pits-------- -- ------- --Lining matercal--- ---------------.Size: Diameter------- ------- --.Depth--------------------------------- ' Cesspool: Distance from nearest well----------------Distance from foundation-------------------.Lining material------------------------ El Size: Diameter-------------------------------------Depth------------------ ---------------------------------Liquid Capacity------ -------- ------gals. Privy: Distance from nearest well__ - ---------------------Distance from nearest buildin - Distance to nearest lot line------- -- - Remodeling and/or repairing (describe):------------------------------------------------------------------- ----------------------------------------------------------------------- - Ki>.4-RGA-----04-D------5,`57--F-M---`----------------------- -------------------------- ------------I--------------------------------- ------------------------------------------------------------------------------------------------------- --------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws, and rules and regulations o the San Joaquin Local Health District. Stgned � / - - .__. x. r(Owner�and..- Contractor) By:-----------------------------------------�1-�--!-®--=----------------------------------------- {Title} J - (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--------{---,-- � ------------------------------------------------------------------------ DATE-----------7_�EVIEWED BY-------------------------------------------- ------------- DATE----- ----- BUILDING DIN PERMIT ISSUED --------------- ----------------------- ------------------- DATE Alterations and/or recommendations:__________ ____________-.- -____ �w. -------------------------------- --------------- ------------------- ---------- --------------- ------------ --- FINAL 1NSPECTION�-BY:.., .. ., �y ;ZCJ 1 � Date_-./� J<� ~- - -- --- ------ -- - ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 11.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California