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FOR OFFICE USE. ------------------- --------- No. I Z _------------- APPLICATION FOR SANITATION PERMIT Permit . 3__ ---------- ------------------------------ (Com lete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued .......... Application is hereby made to the San Joaquin Local Health District fora 7rmit to construct and install the work herein.described. This application is made in compliance with County Ordinance No. 549. i JOB ADDRESS AND LO ATION -' --------- -- .. . '. L ------------------------------------- Owner's.Name------------- A '� L. �- ...- _ Pham_ '� - --------------------------------------- Address---------_--------------= � — �z r ----------- ---- - -------- -14 Contractor's Name---------------------------------------------------------- ------ -��.�._�_- '--- - -�4'�-.•=--`-------------------- Phon7ir/7 Installation will serve: Residenceg Apartment House Commercial E] Trailer Court E] Motel El Other [I #Number of living units: __)_____ Number of bedrooms_, _ Number of bathsLot size ,� �- --- -- ---------- Water Supply: Public system El Community system E] Private 0 Depth to Water Table��.0 ft. � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Z Hardpan ❑ Previous Application Made: (if yes,date____________________) No $�__ New Construction; Yes ❑ No [X PHA/VA: Yes ❑ Nox TYPE OF INSTALLATION AND SPECIFICATIONS: R(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic-Tank: N Distance from nearest well_________________Distance from foundation--------------------Material_______________-__-_.________-._______ ❑ CtS` No. of compartments-------------------- ---Size-----f------•-------- ---------Liquid depth-------•------------------Capacity-- Disposal Field: Distance from nearest well--7.5--.__Distance from foundation._Z _____-Distance to nearest lot line-Z47 47_ . Number of lines----- C 2*L C/ �____Length of each line---�A-El_____ __ -___.Width of trench-._,�-4___ Type of filter material___ 0_C,I`'C_____Depth of filter material____.__-/_--E�-----Total length.______l_6_�__ __________________ ❑ge Pit "' Distance to nearest well----------------------Distance from foundation------___._.........Distance to nearest lot line--_----------_ \ Seeps} • Number of pits----------------------Lining material-----------------------Size: Diameter----------------------.Depth---------------------------- Cesspool: Distance from nearest well________________f Distance from foundation__,_y_____.______.Lining material-------------------------------------- Size. _-_,-._______..__________..__ .___:.Size: Diameter-------------------------------------Depth--------------------------------------------------._Liquid Capacity---------------------------- Privy: Distance from nearest well we ll-_________________ _________________�__.__C_____-Distance from nearest building----------------- Distance to' nearest lot line -_.___ ---• •-•--•-- -- -------------- •---------------------- - Remodelin and or re arrin describe :f -_-__ p�1------- ------_-_-_-_- --------- ------• ------ _ ._. ---------- ------ •--------•----•----------- i ------------------ - I hereby certify that = ve prepared this application and that'the work will be done in accordance with San Joaquin County ordinances, State laws, n rules end regul ions of San Joa in Local Health District. •, (Signed)- ------------ - ---- -- --�--- ----------- -- ----- ` F and/or Contractor) sY� � ----- �- -- - {Title) - ---------------------------- Owner WRBr a ------ --- - - ----}---�----� ------ - ------------- { 'rte 9C_'- •_ (Plot plan, showing size of lot, location of system in relation to' IIs, buildings, etc., caR be plat on reverse side). FOR DEPARTMENT US ONLY APPLICATION ACCEPTED BY-------------I---------------------------------------------•-- ------ DATE------------ `.1� '� I REVIEWEDBY,- -----------•-----------------'-------- --------------•------------ ---------- ---. DATE-TE ------------- BUILDINGPERMIT ISSUED.----ions-A' - -- --��c�_r�t RV+Ra�-•_�i. ------------------------------------------------ ---------- ` ---------- Alterations and/or recommendations:___ '._-!4-_- �_4:- 1�---_ s- -----•-••---------------------------------- --------------------- ----------------------- ------------ ----------------------------------•--------------- FINAL INSPECTION BY:.---- ` ` "`'�-'�- --------- Date----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E6.9 RMBED 9-b9 F.P.DD.2M 6.60