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t'VK Urrll.0 USt: --------------------- --------------------------------- ---------------- ...... ------------ ------------- APPLICATION ---------------------------- -- APPLICATION FOR.-SANITATION PERMIT Permit No. --------------------------- ---- --------------------- (Comp)to in Duplicate) --.--- This Permit Expires 1 Year From Date Issued Date Issued ---.-, P � 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 comF,i..nce with County Ordinance No. 549. , _. tf-so .i :.SC/9LQ/� JOB ADDRESS AND LOCATIV-1-"�TV-RIS.. Qr' Al� _.` _ __ _.►�F �+ Owner's Name------------- -- 4r V_ f (----- --- ------ -r-------...-------------------------- ---- - ------- Phone----------------------------- Address------------------------R_TF--- r- -- ----------- . ox------- � .....--.OAKDOL--�---------------------------------------------2�r Contractor's Name--------•0.WALE?1.5------------------------------------------------- -------------------------------------------------------- Phone----------------------------------- installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms _�,f-._--Number of baths _t!----- Lot size ___AK_R.EJ9_I_a-----------------______ Water Supply: Public system ❑ Community system ❑ Private WKDepth to Water Table-3.571t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [ Previous Application Made: (If yes,date.. ----------I No B----New Construction: Yes ®'lqo ❑ FHA/VA: Yes ?�� No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: --(No-septic tank or cesspool permitted if public sewer is available within 200 feet.) -- - Septic k: Distance from nearest well-__50-----Distance from foundation---A?---------M�t�rial�.��- No. of compartments______�^___.__.__Size__V_��Q_N:7_Liquid depth___ __--__Capacity-.jZOP___- Disposal Field: Distance from nearest weil_.__5Z.)-----Distance from foundation /0 Distance to nearest lot line__>�1:__. [ Number of lines____________ _________________Len Length of each line----- of trench.____.Z---------�' 9 *t ypDepth of filter material_______ r� Total length _1 ----------- Seepage ___`_______ T e of filter material_��.- - g / 1 i See a e Pit: Distance to nearest well....AP------Distance from foundatio � stanc to nearest lot line.._ --6__ Number of pits------/-----------Lining materiak4.5AO_C� er. -_Size: Diamet _.�X-9---Depth...... ____.____:_ Cesspool; Distance from nearest well-----------------Distance from foundation__-_____ lining material------------------------- El Size: Diameter--------------------- --- ----- ----Depth----- ----------------------------------------------Liquid Capacity als. Privy: Distance from nearest well-----------------------------------_--------_____Distance from nearest building----_-------------.__________.____.__.. ❑ Distance to nearest lot line---------------------------- ---- - - ------ - ------------------------------------------------------------ Remodelingand/or repairing (describe)---------- -------- ------------- --- - -----------------------------------•------------------- -------------------------------------------------------- -----I------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ -------- ------------------------------------------- --------------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------•-------------------------------- ---------------L------- ------------ ----------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------- .. 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 regulations of the San Joaquin Local Health District. (Signed) ------------------------------- ---- --------------------- --------------------------------------------- ----------------- --------------. -(Owner and/or Contractor) - Ti+le (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 L f APPLICATION ACCEPTED BY TTt -------------- ---- -------- ---------------------------------------- DATE-------- REVIEWED ---- JREVIEWED BY------------------------------------ -------------------------------------------------------------------------------------- DATE------ BUILDINGPERMIT ISSUED------------------------------------------ -------------------—-------------------- ------- --------- DATE--------------------------------------------- Alterations and/or recommendations:------------------ -------------- ----- ----- -------------------------------------------------------------------------------•------------------------------ ---------- •---------------------------- --------- -------------- -- --- ........... -------- ---------- -- --ROL --------------------------------------------------- ---- ---------------------------- FINAL INSP ----- Date-----------. - - -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT / 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California