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FOW-OFFICE USE: -._-___--._,....-; �. APPLICATION FOR SANITATION PERMIT ~`�'Permit No, .11__..a'_. --------------------------------------------------------- (Complete in Duplicate) _-------------------- - This Permit Ex ires 1 Year From Date Issued + Date Issued S// ..___ � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. t This application is made in compliance with County Ordinance No. 549. 2-6--j- 2to JOB ADDRESS AND LOCATION.------...I o_----------6�-•---- `QTR_Irl 'T------------------------��f�l--C--� - Owner's Name------ ----FRAPR-K----------KQspa-.Tt- '---------------------- ' ' -------------------------------= ... Phone-------------------_----------•-- Address--------PI-0,------- -Y--e--------- �7- ---------- �� '--------------------------------------------•-- ---••-----------------------•--------•------- Contractor's Name------OP.NE-�------------------------------------- ------ Phone..-•--------•---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other ❑ Number of living units: -_ -.___ umber of bedrooms 3- Number of baths __�.__ Lot size ------5- 'x---'-t-•-�--�-' -- ------------------- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table -5-- ft. Character of sail to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date----------------_--) No New Construction; Yes 2- fqo ❑ FHA/VA: Yes ❑ No f TYPE OF INSTALLATION AND SPECIFICATIONS: '"(N6-'septic-tank-or cesspool—permitted—if pub)`i�c sewer'is-av�ilable'within°200"feet:} "" ""` "`�` r Septic Tank: Distance from nearest well____ �+" __Distance from foundation_-__-fO-__._-_-.Materiai----Ra_[�yvr_Q-D___ --._ --. [,/ r No. of compartments--- --------------- -------------Size_3_X5'X--�- 7_..Liquid depth---7-- .. --------.Capacity....E_j----- Disposal field: Distance from nearesstt well..-i- .-.Dis nce odation.__. -`___...Distance to nearest lot line_____ ________ Number of lines_._.__- L of each`cline'---- ^:..' _`_ idth of trench.----- -_i_I---------------- Type of filter material--,f?_0_C Depth of filter material----. _----.Total lengti, Seepage Pit: Distance to nearest well----------------------Distance from/foundation----------------_Distance to nearest lot line--.--_--_---_---_ - OEl Dumber of pets-' ' ---------Lining material---------- -------.h-Size: Diameter=---------- -------De tn---------------------- Cesspool: material 4 Distance from nearest well-_--_-----.--_-Distanrce"from foundation--------------------Lining material---.---__---_--___.--..-__.--__-----. € ❑ Size: Diameter----------------- --- ------ - ----- -Depth------------•-------------------- ----------------Liquid Capacity--------------------------gals. Privy: Distance from nearest well_______________ _F-__--------.-.-.-_.-----.-.--Distance from nearest building-------.-------------------------- -_-. f ❑ Distance to nearest lot line------------------- - ---------•--- :;; ---- -------------------------- - Remodeling and/or repairing (describe):--------------E -------=---------------------------- ---------- ---•--------------•- ---------------•----------------------------------------------------- -----------------------------------_-------------------- --------------------------------------------------------- --- ------ ----------------------"--------------------------------------------------------------------------------------------------------------- 1 Hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Staterlaws, and rules and�regulattionsfthe San Joaquin Local Health District. } 4 - - ------------------------ t (Signed) C.. -- . = ...... ---------------------- ----------------------`t ----(Owner and/or Contractor) Ay: _ _ r •r• ,._ . -_- --------- ------------__._, __- .-, . , (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION-ACCEPTED BY--------- -------' - -----------------------------`' r-------- DATE------ -------. ------------------ REVIEWEDBY----------------------------------- --------- ----------------- ;- '----;--,'';'E J---------±DATE------------•----------------------------------------------- + BUILDINGPERMIT ISSUED--------------------------------------------------------------- -------------------------- ---- ---- DATE--------------------------------___--------------------- Alterations and/or recommendations:._. -Iv+Q:T�F--:----REV(se—_-b--------I.A_ D__'_________________ -------------------------------------- '---- ---------------------=------- ----------- ---- -------------------- ---------------------------------------•--------------- ------------- ------ -'---- # t , -'------•'--'------'-'---------- ----------------------- - ---------------------- ----•-------- ---------- ...' - ---'----------- - ---- -- FINAL INSPEC BY Date.............. �/ z -`-�'-� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California -� Manteca,California ,qcy,California