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FOR OFFICE USE: ' -------------------------------------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. /,/.• .__f.__ ----------- --"---------------------- --- ----- ------ (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 in compliana with County Ordinance No. 549. s n nn J08 ADDRESS AND LjO�CAT] !]�_ -.----n- ----- -------- Owner's - -- n.�c-----�`-li'----0�----J_l��Id 11 --' --->�--t_ �_S._. Owner's Name---------------Rny----------ju,p, _H----------------------------------------- ------------------------------------ ----"--- Phone--------------------------- Address--------------------------------------------------------------------------------------------------------------------------------------------------------------------- C 9DD$ SS~ ) Contractor's Name__QRK>"&I��------pl_ ------ YAR 7-_.'----------------------------- ----------------------------------------------------------------------- Phone.---Installation will serve: Residence `Apartment House ❑ Commercial F] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1---- Number of bedrooms _ __ Number of baths _�L Lot size ------A _KE14(&�-------------------- Water Supply: Public system ❑ Community system ❑ Private Z-111ID-epth to Water Table -10!V ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam >Z(Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-. --------1 No K New Construction: Yes EjllNo ❑ FHA/VA: Yes 21'No TYPE OF INSTALLATION AND SPECIFICATIONS: (No'saPfii tanko esspool pei_mifted-if-pul5lic ewe�'is�availabii*within'200=feet:} ww Septic nk: Distance from nearest well---J- _-Distance from foundation----/Q__-_.__.Material-__ 1 C � �J-----_. + No. of compartments---__Z�_.___.-.----Size__ ___WL1__-----_Liquid depth_.._"6-----------------Capacity_, , Q0-__ Disposal Field: Distance from nearest well-5-10__._.Distance from foundation------fQ_-----Distance to nearest lot line------477- Number -Number of lines_------- r__�--------------------Length of each line_A90—d-0.0...Width of trench.--__- _�� Type of filter material__/3QCJK,.---Depth of filter material-------j ---____----Total length-----------2Q'0------------------ Seepage Pit: Distance to nearest well-_____________________Distance from foundation--------------------Distance to nearest lot line_______-_.______ ❑ 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------------------------------------------ F1Distance to nearest lot line------------------------- - -------------------------------------------------------------------------------------------------------' --.-- Remodeling and/or repairing (describe)------------------------------ ----------------------•---•--------------------------------------•---------- --------------------------------------------- ----------------•---•---------------------------------------------------------------------------------------------------------------------•--•'---------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------- ------------ ------------------------------------------- ----------------------------- ti<. ---------- ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules and regulations of the San Joaquin Local Health District. a (Signed)____ (Owner a on rat ---------------- ----(Ow and/or C t tor] By=; = :_.... (Plot plan, showing size of lot, location of stem•in relation to wells, buildings; etc., can be placed on reverse side]. ��----DD FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- 1 1 F� ' `------ ---- -------------------------------------------------------- DATE------11 �5 ------- f REVIEWEDBY--------------------------------- - -------- --------------------------------- ---------------------------------------------- DATE----------------------- ----------------•-------...--------- BUILDING' PERMIT ISSUED------------------------------------------------------ ----------------------------------------------. DATE--------- --------------------------------------------------- Alterationsand/or recommendations------------------- -------- -----------------------------------------------------------------•------------------ ------------------------------------------- ------------------------ - - "-------------------------- ----------------- ------------------------------------------------------------------------------- ----------------------------------------------------- E ------------ -------------------- ---------- . ---- -- --- --------------'-------------- ---------- ---------------------------------- - -------------- ----------------- ------------------ FINAL INSPECTIO Date........ --------0� P------ e/7 -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.