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'FOROFFICE USE: ------ -------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. : © . zl,_T - ----- --I------------------------------------------ -- (Complete in Duplicate) Date Issued ---------------------------------------------------------- This Permit Expires 1 Year From 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 madein oomplance with County Ordinance No. S49. a _ / JOB ADDRESS AND LOCATION-------------------�� --------- --- -------- RT. F- Owner's Name NLLLLP ----------- © - _Q�.11. ' Phone Address-------------R...& BOX---------- --30_:- -----------�14_THR0-P�------------------------ ------------------------------------------------------------------- Contractor's Name---------F 4_i_ .�-------•---•----------------------------------- ----------------------------------•-------------------•--- Phone----------------------------------- tristallation will serve: Residence [- Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ Number of living units: J----- Number of bedrooms -3--- Number of bathsA� Lot size __1k9f_ ��.._.�__--- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 13 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam G&"Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ { Previous Application Made: (If yes,date -----------...__._) NoR-----New Construction: Yes W+—Iqo ❑ FHA/VA: Yes 21'-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---C_-__-_-__-Distant from foundation--/!(?-7 --------Material---CVAK_�ti ET�. Q� No, of compartments_.__.- ------------Size-_ XJ _X_S.:___Liquid del?th---Z71 ;�._____._Capacity__JZ_Q_Q... Disposal Field: Distance from near sf well--- from foundation---/Q._____-_.Distance to nearest lot line____ _________ Number of lines___ Length of each line_ _ �. ------- ---- -- -- 9 �_�-_�,5-_��Width of trench-----�� ------------- O Type ��__Depth of filter material_.__.__�_9-��____Total length--------------�- ---_____.___.__ T e of filter material __ ---_--Distance from foundation____________________Distance to nearest lot line_-.-_.--_--__-._- r Seepage Pit: Distance to nearest well_______________ �- ----..Size: Diameter------------ ----------Depth--------------------------------- ❑ Number of pits----------------------Lining material________________ 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-----_-___.__._______.______--.----.--..- ❑ Distance to nearest lot line -------------------------------------------------------------------------------------- Remodelingand/or repairing Idescribe)---------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ -------------- - e------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, anjr, and lations of the San Joaquin Local Health District. (Signed')- �� - -------------------------------------------------------------------------(Owner and/or Contractor) V 47 By:---- ---------------- ------------------------------------------------- -------- JR-- --•----------(Title)---------------------- --------- ------ ........ _._. --------- (Plot Milan, showing size of lot, Dation of system in relation to wells, buildings, etc., can be placed-anneverse-sid'e):— FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY........rk.Mt..®.r________________________________ _ ___ DATE._ REVIEWEDBY---------------------------------------------- - -------------------- ------ ------------- ------ DATE----------------------------------- BUILDINGPERMIT ISSUED---------------------------------- - ---------------------------------------------------------------- DATE-------------------------------------- Alterations and/or recommendations-------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- ----- ------------------------ ---- ----------------------------------------------------------------------------------------------------------------------- FINAL INSPECTf Date-------- ( -- ---- -------------------- SAN ---- --------------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ., F.R CO.