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FOR OFFICE US(, ----------------------------------- ---------------- ---- APPLICATION FOR SANITATION PERMIT Permit No. /.?14�45.. --------------------------------------------------------- Amplef� 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 d cribed. This application is made in com;wil/e with County Ordinance No. 549. " , M -------- __.4v......FR JOB ADDRESS AND LOCATIA------- Pilo------A0Q_T)_d----- Owner's Name--------------Rj;AARA>------------N&S.C-1-MI-ENT --- --------------------------------------. Phone----------------------------------- Address----------PVT71_==.J----—---P SC-------2_70--------------MANTIF-C A A.--_-----------_---------- .............................................................. Contractor's Name---- -------to-WAI-Mil---------------------------------------- --------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence JE--Apartment House E] Commercial F] Trailer Court [] Motel E] Other [] Number of living units: --I---- Number of bedrooms 3- Number of baths -7- Lot size -----A CR f=--x------------------------------ Water Supply: Public system E] Community system F-1 Private eDepth to Water Table/O_ ft. Character of soil to a depth of 3 feet: SGravel E] Sandy Loam Clay Loam [-] Clay E] Adobe [] Hardpan C] Previous Application Made: (If yes,date---______-_-_-_) No A-"*New Construction: Yes g?""No E] FHA/VA: Yes El No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic;zK� Distance from nearest well--5Q---- Dista�nnee from foundation------/0.......Mat er�il----- 'fir, No. of compartments-._.__7—----------- Li Capacity...,/Z.49-0. ._,Size_ ---X10 quid Disposal;ield: Distance from nearest well---5-0-----Distance from founds tion___,/.0---------Distance to nearest lot line....S_j-1--- 5900, Number of lines--------:3.---- --------------.-Length of each line__ of trench------ -----------;_-2---f------- Type of filter mate ria I__R0_JCJ��_ --Depth of filter material____.__ ----------Total lengtb-------------------------I------/90 Seepage Pit: Distance to nearest well---_---__-___..___Distance Distance from foundation--------------------Distance to nearest lot line__.-____-_:"___ _ ❑ ine----------------- 171 Number of pits _------Lining material---------- ------------Size: Diameter------------------- ---Depth--------------------------------- Cesspool: Distance from nearest well---------------.-Distance from foundation--- ----------------Lining material----------------------------------- nSize: Diameter----_-------------------------------Depth----------------------------------------------------Liquid Capacity-------------------------•--gals. Privy: Distance from nearest well------------------------------------ -----------Distance from nearest building__________________.._.__-__.-.______--. ❑ uilding------------------------------ ---------- n Distance to nearest lot line------------------- --------------------------------------------------- ---------------------------------------------------------------------- Remodelingand/or repairing (describe):--- ---------------------------------------------------------------------------------- -------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------1----------------------------------------------------- -------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1,have prepared this application and that the work will be done-in accordance with San Joaquin County ordinance State laws, and rules aftsL regulations of the San Joaquin Local Health District. (Signed)_ �__ ------- ze- ----- -- -------------------_ ---------------------------------------.(Owner and/or Contractor) By:--------------------------------------------- --------------- -------------------------------------------------------- --------(Title)---------------------__-------------_--- ---- --------- (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--------- ------------- REVIEWEDBY-------------------------------------------- ------------------- ----------------------- -------------------------------- DATE-------------- -------------- ------------------------ BUILDINGPERMIT ISSUED------------------ ------------------------- ------------------- ------------------------ ------------ DATE------------------------------------------------------------ Alterations and/or recommendations:-------- ---------------------------------------------------------------------------------------------------------------_------------------- ................. ------------------------------------------------- --------7TAyV K-----,",A,' ----------- ----------------------------------------- --_------------_---------- ----------------------------------------------------------------------- --------------------------------------------------------------------- ----------------7-------------------------------------------------------- ------------------------------- ------------------------- --- -------------- ----- ------ --- --- ----------------------------------------------------------------- -------------------------------------------- -------------- ---------------- - - ---- ------ - --- --------- --- ---- -- ----------------_------------------------------------------------------------------I------ ------------- -- ------- - FINAL INSPEC BY: --- --------- Date------------f ___1,1744�-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Co.