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FOR OFFICE USE: -------------------------- ------------- _ -.- -------- APPLICATION FOR„SANITATION PERMIT` Permit No. _ �_ �•._.. ------------------------- --------------------------- (Complete in Duplicate) Date issued __�=_./...--.�-6 I -__________________ __.-._-._..-___..__..-.-.._.--- _-. This Permit Expires 1 Year From Date Issued Applicafion is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. 14 This application is made in com li nce with County Ordinance No. 549. �A >i SIDE JOB ADDRESS AND L CA ON ---I�'-Kl�---7-7------FR TA ------- -—-- r SJR I SAN� Owner's Name____________ ___ _(�f -R_p-z/4 Phone------------------------------ cft Address---------- RTE7_----3-------- m-------/s 3- . ------------------------------------------------- Contractor's Name---QWA1FIZZ---------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer-Coos#-ET' Motel ❑ Other ❑ Number of living units: __/__._ Number of bedrooms _1_____ Numbf baths _/_.._ Lot size --- - r .& ---------------------------- Water Supply: Public system ❑ Community system ❑ er Private Depth to Water Table _ff- ft. Character of soil to a depth of 3 feet: SandGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----------,--------I No New Construction: Yes P—No ❑ FHA/VA: Yes ❑ No P�-� y TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within-200 feet.). Septic T nk: Distance from nearest well----50------Distance from foundation----1Q.--_____.Materi I_..�Q��.r�---.----- No. of compartments_____�=-------.----Size--_ _ 1_QX__S___Liquid yydepth____ —------Capacity-_-f Disposal Field: Distance from nearest well._._J�__Q_----Distance from foundation---/6---_---.-.Distance to nearest lot line---- __..._.. �' V_ Number of lines------------- Length of each line______ __- }z___.Width of trench------ .__.__..-------_--- Type of filter materia1.__94-C)"�-__--_Depth of filter material----_--- 9__-------Total length-------------------460--_--___-.--_--.v► Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line_.__-___-_.---__.El T Number of pits---------------------Lining material-----------------------Size: Diameter-----------------------Depth-------------------:-------------•!�� Cesspool: Distance from nearest well-----------------Distance from foundation----------------_..Lining material...............____,.________._.._-- ❑ Size: Diameter-------------------------------------Depth--------------------------------------------- ,,:,.Liquid `-- -Distance from nearest building Privy- Distance from nearest well g - ❑ Distance to nearest lot 1-ine-----------------------r--------------------- ------------------------- --------------------------------------------------------------------�,, Remodelingand/or repairing (describe)--------------------------------------- ---------------------------------------------------------------------------------- -------------------------- i ��. �.- M. --------------------------------------------------------------------------- -------------------------------------------------------------------, - - ---------- ---------------------------------------------------------------------------------- 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 ales and regulations of the San Joaquin Local Health District. ``4 Owner and/or Con for (Signed(------- �� ```` --------7------- ----- -- ----- ---- . ( / n! � _ ;. :.�- (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 r APPLICATION ACCEPTED BY------1---'�.. ,. 0-------------------------------- --------------------------------------- DATE.------- ----------------- REVIEWEDBY------------------------- ------ ----------------- ------------ - -------------------------------------- ------------------ DATE-- --- ---__-------------------------------------------- BUILDING PERMIT ISSUED----------------------- ---------- DATE__-.---------- _I g" -------- --- Alterationsand/or recommendations-------- ------ -- ----------------------------- ----------------- -------------------------------•------------------------------------------------------------- t ----------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------- ------------------------------------- ---------------•----•----- ----------------------------- -------------------------------- ------------ ----------------------------------------------- -------------------------------------- ----------------- FINAL INSPECTION BY: -f-�- --------- --- Qate " SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Z Stockton,California Lodi,California Manteca,California Tracy,California.