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rUK Url-IU USt: --------------------------------------------------------- -------------- -- ---- -------------------- ----------- APPLICATION ----------------------- -- APPLICATION FOR _SANITATION PERMIT Permit No. ------------------------------------------ --- (Complete in Duplicate) ----------- This Permit Ex fres 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. JOB ADDRESS AND LOCATION 47 � ----------------------- * FCO97 ` Owner's Name-------------Fgn-N—K-----------E-s-ii-N-ok-0------------------- ---------------------------------- -------- Phone------------------------------------ Address---------------- f- ------._,�1I�Lt Al - --- -----------MOF` __-� - A-u - -------------...---.......__.. Contractor's Nam e--------OWIV�F_1 ------------------------------------------------------------ -- - Phone----------------------------------- Installation will serve: Residence O--Apartment House ❑ Commercial E] Trailer Court E] Motel E] Other [-] f I Number of living units: ---t--- Number of bedrooms -J---- Number baths -4_ Lot size .__-.-�------ :!-0 QJF------ Water Supply: Public system E] Community system ElPrivate epth to Water Table '13-ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sa dy Loam E] Clay Loam ❑ Clay E] Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------1 No New Construction: Yes ❑ No L FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: r.� jNo septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation------------------ Material----------------------------------------- -------ah I-Xff> h 4 CNo. of compartments------ ------------------Size----------------------------=---Liquid depth-------------- - --------Capacity------------------- Disposal Field: Distance from nearest well------ .-Distance from foundation-----jl9--------Distance to nearest lot line_ Number of lines_______________ -'__ _..._ --_--Length of each line__.___ ._ ._. �X� F AfCa` - -0.1� _ ' Width of french------------- __ �_�._ .___ '- 19'tType of filter material--ROCK-------Depth of filter material---- -----Total length----/P0----- ---------_`.--_ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line.._----.------.-_ ❑ Number of pits----------------------Lining material-------------.- ---Size: Diameter-----------------------Depth...................___._.-_------ Cesspool: Distance from nearest well-----------------Distance from foundation-__________-------__Lining material-----------------...----- -_---------. ❑ Size: Diameter--------------------------- -- - Depth-------------------------------------- -------------Liquid Capacity------------------------ ---gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------- ElDistance to nearest lot line---------------------------------------------- -------------------------------------------------------------------- ----------------------- I Remodeling and/or repairing (describe)---------- - --------------------- ---- -- --- --------------------------------------------------------- -------- --------------- - ------------------------------------------------- 1 --------) -4F x �t> r1Q1 f .lr ----•----------------- --------------------------------------------------------------------- --------•---------------------------------------------------------------------------------r*.R_.D---------------------------------- - I hereby certify that I ha.xp prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws, and rul s and regulations of the San Joaquin Local Health District, i (Signed) r ---- --------------------- -------------------------------- ----------------- ------(Owner and/or Contractor) By:------------------------------------------------------- - ------- -----------------------------------------------------------------(Title)---------- -- - --------------- . �. (Plot plan-showing size of lot, location of s .stem ',, relafion.to wells, buildings, etc.,.-can be placed on reverse side). _ FOR DEPA MENT USE ONLY APPLICATION ACCEPTED BY---- �_ i_.Q-'----------- ------- -------------------------------------- DATE.------ � � :: REVIEWEDBY---------------------------- ----------------- - --------- ------- ---------------------------------- DATE------- ------------•----------------------------------- --- BUILDING PERMIT ISSUED---------------------- - - --------------------------------------------------------------- DATE - -- --------- Alterations and/or recommendations:----------------------------------------------------------------------------------------------------------------------------------------- ------ ---------- ------ -- -------------------------------- ------------------------------------------------------------------------------ --------- ------------------ ---------- - ----- -------- ------ ---- -- - . -------------------------------------------- ------------- ------------------------ - ----------------------------- FINAL INSPECTI (//l- ---- ----- -- -- -- DateC SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 West Oak Streret - 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi,California Manteca,California Tracy,California F.P.00.