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FCR 01`1�'CE USE: w APPLICATION FOR SANITATION PERMIT Permit No. ------- (Com lets in Duplicate) P P ) Date Issued ------ -------- - -----------------------------;-____----- -------------- This Permit Expires I Year From 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. (l 6-7-7 s f 1 t JOB ADDRESS AND LOCATION = /` [1LR�Lf1_ b = � 40L )�� Ll17SATF1_ 4JP Owner's Name----- -•------- -------Cw-'_----------------------- ------ Phone............... •-----------. Address---------/ Cld�f�I�NI2 d i1(�' ---------- f T}� �7 r------C'g 1 —=--------------•------- Contractor's Name"------PR- RIS-�-------Mr-C-;---------------------------------------------------•--------------------L-------•------ Phone----------------._---------------- Installation will serve: Residence ❑',•j Apartment House ElCommercial Trailer Court ❑ Motel ElOther E] Number of living units: _ ___ Number of bedrooms :=.- Number of baths Lot size ____ ----"•--------------------- '1 ----rl Water Supply: Public system ElCommunity system E] Private Depth to Water Table /2-ft. Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote._---._.- -------) No R`_ New Construction: Yes 2 --No E] FHA/VA: Yes ❑ No 2— TYPE OF INSTALLATION AND-SPECIFICATIONS {No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wet{---• -0--__Distance from f29 ndation-----L�.-------Material_601�CIR. ---PAE_FF}L� [tr_ No. of compartments------- --------------Size __ ------Liquid depth----,-�-----------Capacity---3-� ®-- Disposal Field: Distance from nearest well-....5- -.._Distance from f ration_____. _ Istance to nearest lot line---- Disposal 10.-- -. . 4� r, Number of lines---I-------�/--------------------Length of each line--- ' _ _}' idth offrench.-------��--..----- ----------/0 Type of filter material__RQ_C.K ---Depth of filter material---.--/_�______._._Total length__________________________ l:lf Seepage Pit: Distance to nearest well----------------_-----Distance from foundation--------------------Distance-to nearest lot line----------------- Q ❑ Number of pits--I-1-----------------Lining material----------------------.Size: Diameter Depth I Size: Diameter-_nearest well from foundation__- _-_.___._--.Lining material_________________________.___-____ r Cesspool: Distance from n`I ---Depth----------------------- -----------------.-Liquid Capacity----------------------------gals. Privy: Distance from nearest well.------------------------------------------------Distance from nearest building---------------------------------- ._____- ❑ Distance to nearest lot line-------------------- ----------------------------------------------------------------- ---------------------------- -------- -------- Remodeling and/or repairing (describe)------- -- ---------------------------------------------------------------- •------------------- ------------------------------------------------------- ----------------------------------------------------------- ------------------- 1 -------------•----------------------------------- ---- it --------------------------------------------------------------------------------------------------------------- -------- - --•----- - - --- 1 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 regulations of the San Joaquin Local Health District. t I _-Owner and/or Contractor (Signed)--------- -IL}3��1�_ ------�/1��.�- - --------------- --------------------- - ----------------- ------- ------------- ------ { -/ - - - -- f— -- — — Ry=------ - --r - =�'-------- - ------------------------- {Title) 5 .: - (Plot plan, showing size of lot, I ation of system in relation to wells, buildings, etc., can be placed on reverse side). '1 FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- - R-= ---------------- --------------------------------------------------------- DATE-------- I;--- r�-- ------- -------.--------- REVIEWEDBY------------------ ------------------------- ----------------- ------------------------------------------ DATE BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------------------ - ---------- -----------------------------------•------------------------------------------------------ i ----------- -------------------------- ------------------------- - ------------------ •-------------------------- I -- ---------------- -- --------- --------- --R--------- ------------------------------------------------ - ------ Date--- ----� --------------- ----- ---------------- FINAL INSPC BY:. e-) SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Hazelton Ava. 300 West Oak Street 124 Sycamore Street 205 West 9th Street s: Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.