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FOR OFFICE USE: f ------------------------------------ --- ----------------- X83 __._ APPE!,CATION FOR SANITATION PERMIT Permit No. ....................... (CompIlete•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 w'th County Ordinance No. 549. JOB ADDRESS AND LOCATION---- ----- ---------- ------- f". ...... . _M_A1VL�.A------- `----------A9` _R Q. ' Owner's Name---. ---•-- � R. L -------- ------------------------------ Phone__.-----------•------------_---- ---.-�-1_�----------- -1'Y�A� Address-----•------------------•----�--� - - - -- - - -- ��-1�.'}�---•----•--R.�-•----•--------------•-----F--A�H.R_Q_�.`------------....---- Contractor's Name---0 11f. - - -------------_-• ----.------- 1 --------------•- ------- ------- --------------------------------------- Phone..---- -------------------------_- j Installation will serve: Residence 111 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [j :. r � Number of living units: __R-_ Number of bedrooms __9 _._ Number.of baths _2-- Lot size ----AS ___X.-_I S-___.____--.--.__,, Water Supply: Public system ❑ Community system ❑ I Private ®/Depth to Water Table 2o- ft Character of soil to a depth of 3 feet Sand E] Gravel Gravel Sandy Loam [:] Clay Loam C] Clay E] Adobe [-] Hardpan \ Previous Application Made: {if yes,date_..... ) Not❑ 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.) - i E M + rial ..eQ _ - Septic T k: Distance from nearest well__-�.._.------Distan e from foundation_.. __ � No. of compartments..._. X ____X 5--,---Liquid depth-__ /Z„_-.-._.Capacity.12______ _________ rL- ._Size-- ----• ® � I Distance to nearest lot line--_-_ Disposal Field: Distance from nearest well-.S� ---Distance from foundation .--ID_... __.. �.__...... �f Number of lines - i----- ---- -----------------Leh gth of each line------ ___ ... Width of french------ <<_____.__�_.. �,..._. Type of filter ma+erial__RQ CK_ _ -Depth of filter material----- _ __ Total length______------------- Seepage ____________�Z_ See❑a e Pit: Distance to pnearest well---------------- Distance from foundation---______..____--_.Distance to nearest lot line_____-_._-__---._ p 9 t . Number of its--. I----------------Linin material---------------------- Size: Diameter.---------------- Depth--------------------------------- Cesspool: --------- ----------------------Cesspool: Distance from nearest well ________________Dirstance from foundation----------------- ..Lining material_---.-____---___.____...____.__. ❑ Size: Diameter- .-'. Dth.�-------- ----- ---------------- e -__-._...._..-.______----------------------------Liquid Capacity gals. t f1 J. Privy: Distance from nearest welf-------------------------------------------------Distance from nearest building-------------- _-_-----------------___-.. I ❑ Distance to nearest lot line ---------------- I------ ------------------------------------------- ------------------------------------------------------ Remodeling and/or repairing (descrihle):-- ----- -------- -------------�- -------------------------•-------•------------- I ---- ---- --- ----------------------------------------------- -- - - ------------ ----------- ------------------------ --------------------------------- ----------------- ------------------------------------------ ------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, St to laws, and rules d`reguiatiorss of the San Joaquin Local Health District. �A �h - - - Owner and/or Contractor ned 5i _ By:-------------------------- --------------- ---- ------------------------------- - - •- ------ ---------------- ------- ----- ------------- -------------------------(Title)------------- - ---------- - -------- ---- - - -- (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ' " FOR DEPART NT USE ONLY APPLICATION ACCEPTED BY---.- .rte DATE-----rL--r. -` '.. REVIEWEDBY - M -----------------------=-------------- DATE........ -----------•-----------•--------------------------- BUILDING PERMIT ISSUED-------------------------- --------------------- - I )----------------------------------------------- DATE.---------------•------------------------- ----------------- _ --•-----•------ --- ----------------------------------Alterations and/or recommendations:-----------------�- - It --------------------------- --------•--------------------- --------------- i --------------------- ------------------------ ----------------------------- ------------- - ----------------------------------- ------------f -------------- ------ --------------- -------- -------- ------------- ---------------------------------------- ---------- ---- = - ............IM------------------------------------------------- ----------------------- ----------- ---------------------• --------- ---- ----------- ...................... -- - - FINAL INSPECTION BY:- ___'.....1---_.-._-._ Date .�_ 3 ) � l� , SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Streal 124 Sycamore Street 205 West 9th Street s Stockton,California Lodi, California Manteca,California Tracy, California E.H.9 2M 1-67 Vanguard Press