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FOR OFFICE USE: , +x ----- APPLICATION 2APPLICATION FOR SANITATION PERMIT Permit No. ---- -- ---- ----- -.-- (Complete in Duplicate) Date Issued This Permit Expires t 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 irj com�nce with County/Ordinance No. 549. 1 JOB ADDRESS AND LOCATION_--___�-.-__t9_r.R.r _t -r _ -_s�.J� � .. _� __ �. .. R�V� Owner's Name-----------------14E.N -X------------ --- - -------------- Phone-----•------------------ - Address................19-1-F97..........- 0.3----------/4V�--------- -------------4::xC-)-F-1............................................. Contractor's Name--- O.WJV F— --------------------------------------------.------------ Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [c]•-X04814 Number of living units: j---_ Number of bedrooms _Z__ Number of baths I---- Lot size ------- —---------------- Wafer Supply: Public system ❑ Community system Uj-'Private ❑ Depth to Water Table IS._ ft. Character of soil to a depth of 3 feet: Sand 2_11�ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No R;___4�A: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 feet Septic Ta Distance from nearest well_C --Dista ce from foundation--..1 _.-_--..Marial--.4'��CT .,,____. [ No. of compartments------�--_.__.-_.. _Sizey_X1_Q_X-_�..___Liquid depth-_Est'ance 7 ---.--_Capacity_-1Zaa---_ tA Disposal Field: Distance from nearest well-C�.W Distance from foundation .��._______ to nearest lot line---- ---_- ❑ Number of lines--------------- �-_0_4K-_Depth -Length of each line_-___- Q__- - -----.Width of trench---_-.�q.IL_.-.._----_-- _-Type of filter material-_-_ - of filter material------ ..........Total length----------------------gQ----___--. Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----_-_-_-------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth---.----------.-____--_--.___- 0 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_---.----_-_---_-_---------------- - Size: Diameter--------------------------------------Depth--------------------___ -___-_--__-Liquid Capacity ------------------------gals. A, Privy: Distance from nearest well--------------------------------------- _-.-----Distance from nearest building-------.--.--.-_--__-_-_-_--_-.-----.-. ❑ Distance to nearest lot line---------- ----------------------_----------------------------•--------------------•-------------------------------------------------------- } Remodeling and/or repairing (describe):------------------------------------------------------------------------------------ LA e -----------------------•-•-----------•---------------------------------------------------------------------------------------------------------------•----------------------------------•--- ----------------------- ------ ---•-------------------------------------------•-----------------------•--------------------------------------------------•--•--•----------------------------------------------•--------------- ----------------- ------------------------------------------•-----------------------------------------------------•--------•------------------------------------------------------------------------------•------------------- G I hereby certify that I have prepared this application a that the work will be done in accordance with San Joaquin County ordinances,�Sifafe , and rules and reg ins of the Joaquin Local Health District. (Signed ------- ---------------- ------------------- -- ------------------------- ------------------------------------- -----------------------------------(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 S APPLICATION ACCEPTED BY..... -- __------------------------------- DATE `-/Ez-- ----------- REVIEWEDBY---------------------------------------------------------------------------------------------------------- ----------------- DATE------- ------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------- ------------------------------- Alterations and/or recommendations:_------------ ---------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------•------------------ ------------ ----------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- --------------------------------------------------------------------------------•----------• ------------------ ------------------------------------ ---------------------------------------- ------------------------------ ------------------------------------------- ------------------ -------...---- -- - --------------------- --------------------------- FINAL INSPECTION BY:...... �. -....-__ p "�----. �� ao+�.>;vJ----...----•----- Date----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20S West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. <