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vR viri%..e V.)C: -- . ---------------------------------------------- --------------- --------------- -------- --------------- ----- APPLICATION FOR SANITATION PERMIT Permit No. ...... . -�- � ------------- ------------- ------------ ------------- (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 compliance with County Ordinance No. 549. �H�Q 3 f Direr I 1 < JOB ADDRESS AND LOCATION-------------a. Owner's Name --�Z6 .. � - 1 Tf3 �rsfF'1u ..1 _RU Phone Address rFE:-=-�. ......D ------91-0----------- ----- - THRO-P--:--------------------- - - - - Contractor's Name---------FL,LI�-�----- ----P--• --------•--- Phone Installation will will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -..I-.- Number of bedrooms _2,Number of baths -�_. Lot size ---A-CR.EF,,C17 --_ -------------- Water Supply: Public system ❑ Community system ❑ Private >/�6epth to Water Table /0 ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date.----------- ------) No E----New Construction: Yes ❑ No jE-- FHA/VA: Yes ❑ No ®� TYPE OF INSTALLATION AND SPECIFICATIONS: m {No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_---�0----Distance from foundation...10._---- Material..CQ� }� Rte[ -RGA No. of compartments....._-- r —. -----Size-- X-10.X.S.Liquid depth_ Capacity... C? Disposal Field: Distance from nearest weil__5S ----Distance from foundation..--- - TI ./r.-......Distance to nearest lot line.. -- h Number of lines............. Length of each line------�,�-..`. Width of french__..-�--- _.------ ------------------- Type of filter material-_--__ Q C_ Depth of filter material_-..,9---___-..Total length------------------,7, --------- --- Seepage Pit: Distance to nearest well-----------------_----Distance from foundation--------------------Distance to nearest lot line-------- ❑ - Number of pits----------------------Lining material---------- ---------- Sze: Diameter---- ------------ ---Depth.................................. - Cesspool: Distance from nearest well.................Distance from foundation_-------------------Lining material-----._-----------------.---____ - ❑ Size: Diameter______________ �. --------------- -----Depth--------- --------------------------- - -------Liquid Capacity-------------- -------'-----gals• g Privy: Distance from nearest welF------------------ ----l.. ---------Distance from nearest b0din T ❑ Distance to nearest lot line - Remodeling and/or repairing (describe)-------------------------- ------------------------------- ------------------ --------------------------------------------------•------- ---------------------------------------------------------------------------- --- ------------------- ---- 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 and r��ep�ulations of the San Joaquin Local Health District. {Signed}----- jr�c�t.C!{ ------------- ---------------------(Owner f T -- -------- - -- ----------------- --------------- ( rand/or Contractor) B . GG% Y•-------------- ---------=---------==--�=-_-:.�----=-- -----------•------ - ------------------ -------------------------------(Title)--------------------------------------------- (Plof p an, 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---------71_f_&�.)------- -------------- DATE---------- --- �-- 5 ---------------- EVIEWED BY----------------------------------------- --------------------------- DATE---•------- - -------------------- UILDING PERMIT ISSUED-------------------------------------------------------------- ----------------------------------- HATE-- ------------------------ Alterations and/or recommendations:--------------------- - ---------- --------------- ---------------- - - -- -------------------------------------------------- FINAL INSPECT] -- ----------- - - Date------------- -- 6( ------- - -- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT, 1801 E.Hazolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy, California