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FOR OFFICE USE: s �- ------------------------- - - --- -------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------- ------ --- ---------1-- -- (Complete in Duplicate) -.--- This Permit Expires 1 Year From Date Issued Date Issued --- Application 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. JOB ADDRESS AND LOCATION...... -- -IV -RSH---------PaPt_1�p---- ---------. OwnerName 11, 1._ RD» ' =' Phone ---------------------- - �, .�. . ------------------- Address�...............-'�1 11� �!--Q-r� .. . Contractor's Name_______-___OW-14_ER--____--------- =---------------------------- ----------- Phone....-------------- ----------------- Installation,will serve: Residence t � ence �� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I----- Number of bedrooms _ Number of baths _ __-._ Lot size _. �__X__-_L .------------------------- Water Supply: Public,,system ❑ Community system ❑ Private Depth to Water Table ft. p of 3 feet: ,Sand [Gravel ❑ Sandy Loam ❑_,Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Character of soil to a depth y ] No New Construction: Yes / ❑ �'" Previous Application Made: (If es,date_..___.____ �No ❑ FHA VA: Yes No _TYPE'OF INSTALLATION:AND..SPECIFICATIONS: ,� �: :: - �- :- � (No septic tank or cesspool permuted tf;'public sewer is'available wtthm 200 feet.)`v Septic Tank: IJ_istance from nearest well-----------------Distance from foundation-_------- 56 _____ _______.Material________-_--_-__.-.__._.___________._____-_____- D s ,�Id: Diostanceompartmen,ts _ .-----------Size---------------------------- ---Liquid depth--------------------------Capacity---------------------- p fromn � f � ti Bares# well.�' ="°_ Distance from foundation________-_�--------Distance to nearest lot line________________ I EX[ 'F! Number,iof lines)-`1 ---------------------------Length of each line--------------------I---------Width of french------------------------------------ : Type of(filter'material-_______i----------- Depth of filter material----------- !--------Total length________________________________________- Seepage Pit: Distance to nearest well----H75__-__--_-_Distance pfrom foundation____.f __........Distance to nearest lot line.__,______--_ _ Nur ber��of pits_---1...l-_-_-_____Lining material---IZ-0.61�....Size: Diamefer-3--K-2- __-Depth...... - I Cesspool: Distance from nearest well________________Distance from foundation------------------- Lining material__ ------------------�------------ ❑ Size: Diameter------f-s-s----------------------------Depth-------------- -------------------- ----------------Liquid Capacity--------------- -----------gals. Privy: Distance from nearest well ________________-----------------------------._Distance from nearest buMin Distance to neareSt'lot line Remodeling and/or re airing (describe]:----- d ... -*x_--10, ------A/vjvrs< c( ------"r-o----------------- - -- i -N1# i[T CA. nfN -t ------ 'D------- - W_ R -------SJ5S------- T -------------- _ r----------• e----- -------------------------------------------- ---.-I hereby certify that I a� i �:{ '------------------------------------ ------------------------------------------ ------------------------------- �ave prep ed'thisapplication and'fhat-the work will be done in accordance with San Joaquin County ordinances, Sta la n s al6rregulations of the San Joaquin Local Health District. (Signed}--- ------ � --#--- -.,.�----- -------------I-T--i-t--E-e-}------- ---- ` `'__.(Owner a�nd/or��Contractor) ►kms k ---� -------- mo .- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). , FORrdtPARTMENT USE ONLY APPLICATION ACCEPTED!BY---- ----------------------------------------------------- DATE------f✓FZ �/4 - 01V- REVIEWEDBY-------------'------- '`----------------- ---------------------------------- -------------------------- --------- DATE BUILDING PERM IT,ISSUED- ::-• - :;------ .---_---- --- DATE------------------ ------.. _ �_ .. Alterations and/or'recommendations: -= - �.. A - ---_ --- ------"-- --- t ----------_--------.-------------.--------------- - --------- --------- - _ _ --_-----_-_-_.__-_____-.-______._-_--__--___-_______________-_____ _.___----__-_-_____--_____---------- ---------------------_---_- -_P_-- ------ ____ _------ ...... _ ___- -___!_ ----------------------------------------_.__-_____-_..------------------------------------- FINAL INSPERCT1ON—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