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rt :K Ut-M-L USE, .^� ' ._.—-------- ----- --------------------- _ ----------------------------------_--------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------- --------------- I (Complete in Duplicate) -- .-- This Permit Exres 1 Year From Date Issued Date Issued ___� j�./_ -r 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. Z 2-7-Z2C1-21CR LQ/� W s1 Dts1.., �rs j 1 JOB ADDRESS AND`�LO—D_: ] IT _ f. .,,. -- �� Owner's Name ----t �- - - 11 Q _ _. C _R-- ----- --- --------------------------- Phone-----------•-----------•--------•--- f Address.. RTe�_:n �y-7 ..............j_ - } Contractor's Name...8t} jmL — t COIVCtile ----- pf_p�---->M—R ?---•------------------ ---- Phone__9_9.7--174b--- Installation will serve: Residence Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ -_ Number of bedrooms __5__ Number of baths _2--- Lot size ----A_C4R1C-A_&I _____________________._ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _90 ft. Character of soil to a depth of 3 fee t : Sand ❑ Gravel [-] Sandy Loam Clay Loarn Clay ❑ Adobe 0 Hardpan Previous Application Made: {If yes,date__._...............) No E' New Construction: Yes ❑ No Le'� FHA/VA: Yes ❑ No [� r . TYPE.OF:INSTALLATION AND SPECIFICATIONS _.. R�VR(No septic tank or cesspool permitted if public sewer is evadable within 200 feet.) f# 1 FSeptic Tan Distance from nearest well__ Q_____Distance from foundation----fp-____-- Material_eQ1C ET.,I,�_ No. of compartments_______ ___ Size_ �i_�_X � - _--Liquid depth__._. _Ca y__.__ t 1posal Field: Distance from nearest weN___-5a__-._Distance from found at'on---- Distance to nearest lot line---__57� Q Number of lines:I-------Z-_--------_--------Length of each f line------ ---� Zf[� 't . _____--TYPe of filter materia �__ Depth of fter material Total lengfh___._-_� - �.. -----------------_---- Seepage Pit: Distance to nearest well ___ .-Q-Q_ Distance from foundation____, - --- ---- �:______.D'stance to nearest lot line____S___:______� Irs �-` Number of pits---,_,____-_-------Lining material__---/?05;7X_Size: Diameter_2- _ --__Depth-------- Cesspool: Distance from nearest well-----------------Distance from foundation---____--------------Lining material------------------_--___.___.___-_- '? ❑ Size: Diameter---0A -- -- ----Depth------------------------------- ------------------- Liquid Capacity----------------------------gals.ok Privy: Distance from nearest well----------------._. ------ ____________Distance from nearest building' ❑ Distance to nearest lot line----------------- - -- ----------------------- Remodeling and/or repairing (descri/be):------131-po_)_R)AES---`1`--- rtRnlSSS---`------------4-? --------top, �l�v�l DF � �/T�-------------r-kKQ--------------------------------------------- --------------------- -- ------------------------------------------------------------------------------------------------------------------------------------------- ------------------ -------- --------------------------------------- , ,�4BAT: D-i - - ------� ---------��---100.------ � I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules ire gulations of the San Joaquin Local Health District. (Signed)---- Fl -..... `[a_--- /p y14D- (Owner and/or Contractor) BY: v Ts_I .K. (Plot plan, showing size of If l t�locatiori of system in relation to wells, buildings, etc., can be placed on reverse side). r i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... - s-��-----_.-.----------------------------------------------------------------- DATE_-------- REVIEWEDBY----------------------------------------I----- -------------------------------------------------------------------------------- DATE- BUILDING PERMIT ISSUED-----------------I---------------- ------------------------------------------------ ----------------- DATE - -- ----------------------- Alterations and/or recommendations:___-------------------------------------------------------- _.______________ __ r - ------------------------------------------------------------------------------------------- -- ------------------------- ----------------------------------- FINAL INSPECTI 4Date------ --------------- ----- ------------------ SAN -= SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ka:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.ra. r j