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FOR OFFICE USE: r f -- --- --- - - - _ APPLICATION FOR SANITATION PERMIT Permit No. _ 1J, � y------- (Complete in Duplicate) __-._--.-__------------------__-_-- --------- This Permit Expires 1 Year From Date Issued 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 incompliance w'th County Ordinance No. 549. M-MA JOB ADDRESS AND LOCATION PF-._-7o-----At Ap-m-r-..Uu�_-__-_.____ A.RPD -____---A-131[1--___--!;R Owner's Name-------------------------DQN_Q V a_ --------- ------�S.HANJIIL------ --------------------------------------- Phone.--................................ p�_ 1► g ------------------..SUNN. A A L l F-•---------------------.. Contractor's Name--------2W/VER-•------------------------------------------------------------------------------------------------------------- Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer.Lowt Motel ❑ Other ❑ Number of living units: ...I-- Number of bedrooms -1---- Number of baths _/-_-_ Lot size ------T0___1t.....�Z_7Q------------------ Water Supply: Public system ❑ Community system 2rPrivate ❑ Depth to Water Table 1.�'�___ ft. Character of soil to a depth of 3 feet: Sand J�r'Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No �lew Construction: Yes ❑ No Pq--fHA/VA: Yes ❑ No jI._ TYPE OF INSTALLATION AND SPECIFICATIONS: _(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se Septic T nk: Distance from nearest well__�W-_ Distance from foundation----/l-1_---------Ma�er'al__�_��: �Tg_.--------- I [F No. of compartments_------ ---------Size-_V_XLQ__X.__-�-___-Liquid depth_.��Z__.---_Capacity....�Z .p-_- J Disposal Field: Distance from nearest well.C.W�._Distance from foundation.-J_0----------Distance to nearest lot line._._.______- Number of lines.---------f-- _ _ _ -__ -. ____:-_____-- _--Length of each line---------- Width of trench------------#-------------- Type of filter material--_- 4Q.C/ _..Depth of filter material-------� ----------Total length_-_-_-::---9 _-__________________ Seepage Pit: Distance to nearest well-------------- -------Distance from foundation--------------------Distance to nearest lot line----------------- 0 ❑ Number of pits---.----------.-------Lining material---------- ------------Size: Diameter-----------------------Depth------.-------------.__------..._ Cesspool: Distance from nearest well--------------_Distance from foundation--------------------Lining material-------------------__---_-_____--_- ❑ Size: Diameter-------------------- ----------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. ' Privy: Distance from nearest well--------------- ---------------------------------Distance from nearest building----------------------------------- 7 -_----. ❑ Distance to nearest lot line------------------------- ------------- ---------------------------------------------------------------------------------------------- O Remodeling and/or repairing (describe):---------- ---------------------------------------------------------- ----------------------------------------------------------- ------ - --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- --------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. �j�14— IBY: (Signed)---------- ------- V`'Z�Z------✓ -------------------------------------------- ------------------------------(Owner and/or Contractor) ------ - - -- ------------- -- ---------- - --- ----- - (Title) ----- (Plot plan, showing of lot, location o ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYr �D' SATE-------- >-. --- REVIEWEDBY------------------------------------------- ---------- ---------------------- ----------------------------------- ------ DATE---------------------------------------------.............. BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- -- DATE. ---------------------------------------------------------- Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------------------------- ----------------- ------------------------ -------------- -------------------------------- - ------------------------ ----------------------------------------------------------------- -------------------------------- ----------------- ----------------------------------------------------------------------------------------------------------------------------------- ------------ ------------------------------------------------------------=------------- --- - --------- --- - -- ----- ---- ------------------------------------- ---- FINAL IN CTION BY: - ----- --- ---- --- - - -- ". Date.------------- 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.CC. h