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rVK VrrICt ubt: � - --------------------------------------------------------- 3cC a)foI, Z01 off ------------------ _____________________ APPLICATION FOP, SANITATION PERMIT Permit No. ;;/ ------ --------------- -------- --------------- (Complete in Duplicate) ------------ ----- ------------------------- This Permit Expires 1 Year From Date Issued ? Date Issued Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and inshall the work herein described, Thisapplication is made in compliance with County Ordinance No./549. JOB ADDRESS AND LOCATION-RX-53 ny� ------------------------ Owner's - ----- 1 � _ =sip'-"_ ✓ l`�i Owner's Name-------- ---------- ------- --- -------- ----------------------------- ----- Phone--------- _ - Ad dress----------•-•- �/e_ ---------- --------------- - -- - -------------------- ------ ---------/ Contractor's Name________._____.- __ J � -- - -- -------------------- ------------- r-�,�,� ----------- Phone---- nsta lotion will serve: Residence ••----- --•--- *�- apartment House ❑ Commercial ❑ Trailer Court E] Motel p Other ❑ Number of living units: --, .- Number of bedrooms __2- Number of baths __/__ Lot size --- �� Water Supply: Public system ❑ Communitysystem .....--__ x____________________________•-- Y ❑ Private �epth to Water Table _Y�.ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe E] Hardpan Previous Application Made: {If yes,date - - -..) No ❑ New Construction: Yes ❑ No f_4--'_FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic rink: Distance from nearest well__ -_r--___Distance from foundation--/-5-7- ---_,Materiai___ r No. of com artments___--- ------------------Size___ f p -�.-/Y=5`,!l ---Liquid depth------- -Capacity. Disposal Field: Distance from nearest well_________________Distance from foundation_______.__.______.Distance to nearest lot line_-____ - ❑ Number of lines------------------ ------Length of each line---------------- Type Width of trench---------------------_---- ------- ype of filter material-______-___- Depth of filter material__.__-______. ._---Total length______________---___- ------ ------------ --------Pit: Distance to nearest well_ ______Distance from foundation__________-________ Distance to nearest lot line_._____.__.._____ ❑ Number of pits----------------- ---Lining material------------------ -..Size: Diameter----------------- - ---Depth------ ---------- ---------- esspool: Distance from nearest well_________________Distance from foundation---.------.---------Lining material---------------------__---_----_ ---k Size: Diameter--------------------- --- -------- Qepth------------- ------- --- - --------------Liquid Capacity alsV - -- - - ---- rivy: Distance from nearest well__________________ ___ - ----------Distance from nearest buildingEl Distance to nearest lot line________________ ------------------------ Remodeling and/or repairing (describe):-------- -- � ----------- ------- ---------------------------------------------------- ---- ------- --------------- ------ --------------------- ----------- - - ----- - --------------- - hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, and rules and re ulati s of the San Jo quip Local Health District, (Signed)------------------ - --- 9: P ---------------- � - er and/or Contractor) { gY` = ------ {Title) - -- ------ - --------------------------------- (Plot plan, showing size of lot, location of system in rela • to walls, buildings, efc., can be pl ced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-. _ --------- __ REVIEWED BY ------------ DATE---- ---------------- - - -- ---------------- ----------------- BUILDING --------- ------ ---- ------------------------------------------------------------- DATE---------------- ------------------------------------------ -- ----------- BUILDiNG PERMIT ISSUED------------------ -- ------------------------- ---------------------------------------------- -------- DATE Alterations and/or recommendations:-------- ------------- _..___-..._____ ---------------------------------------------------------------------------- ---------------------------------------- - - ------- --I--------- FINAL ---------- - FINAL INSPECTION BY , : � � -- r 5" _ s'' -..Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,CollFornia Lodi,California Manteca,California - f Tracy,California F.p.CO.