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t-UX Ul FHCE USE --------------- ------------------------------ ----------------- -------- APPLICATION, FOR'SANITATION PERMIT Permit Na. ---------------- -------------------------------------- (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. 544, JOB ADDRESS AND iLOCATION-1--l-- ---------------------------------- ll- _ Owner's Name R V 1v U r`L L ----------------------- ------------------ 12- Address ---------------- Phone U 9 Cc } Address.--------•------------- -- � �&1 k g/-6- ��) 0p Contractor's Name--------------------lI�._lltuz_5-----[ l _I Nti n- --O S--4 -------------------------------------------- -----_-- Phone - - ----- Installation will serve: Residence ❑ Apartment House E] Commercial ❑ ❑ Motel Trailer Court ❑ Other ❑ I Number of living units: - _ Number of bedrooms ___- Number of baths _1_ Lot size -----IA-q---X-----` -- - -r_ . ------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- 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 [2 New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ WNI�_Distance from foundation__-_-1 b C� 14 C' RE T� -- -- ----.Material- ------- ----- ------------------ ----- No. of compartments------------�--------Size---h>P-_e5 1------Liquid depth-------- --1�-- -.Capacity__-- -g r ------------- Disposal Field: Distance from nearest well_- ---------Distance from foundationDistance to nearest lot line____ ElNumber of lines--------------------------- ----- Length of each line----------�fA-------------Width of trench------------' --------------- \, Type of filter material________________________Depth of filter material----------------------- length--------- -- �11 ' ------------ F Seepage Pit: Distance to nearest well-- Dist ante from foundation___�Ud--�.___ Distance to nearest lot line__._1__�____ Q- . ❑ Number of pits_1---------- ---Lining material-_---f ------Size: Diameter--------U-----------Dept h----.---_ -------------------- Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material_-...._.__.__.___ ❑ Size: Diameter--------------------- ----------------Depth---------------------------------- -----------------Liquid Capacity--------------------------_gals. Privy: Distance from nearest weft_________---------------------------------------Distance from nearest building ` ❑ Distance to nearest lot 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, Sta+e%s, and rules and reg lations of the San Joaquin Local Health District. (Signed)------ -------- - V --•• ------------------------�-� ----� - --�--- ---------------- - ---------------- --------------- --- ---------------------(Owner and/or Contractor) �Y=- (--------- ------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B ---- Pte- ---'-- ----------------- _ DATE----------- 2.Z- REVfEWED BY ---- ------ DATE BUILDING PERMIT ISSUE, --------------------- DATE----------- c •• -- ------------------ Alterations and/or recommendations:_..__..__'Z�.'�' -:- � --------------d l� --- ---------------------------- -----------• ------------------ ----------- ----------------- ---- ---------- ---------- ' FINAL INSPECTION BY Date------------- ---- SA JOAQUIN LOCAL HEALTH DISTRICT 1601 E.fdaseltoo/eve. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California I Lodi,.California Manteca,California Tracy,California