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N APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Permit No. Date Issued --- 41 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_-, /o/ -------- le6 � A --------------- - -------- Owner's Name --------------- RV/V2-ar,, - ------- ---------- ------------------------------------------- - Phone------------------------------------ 5 Address hone------------------------------------ Address-------------------- 1_2__& ------------- --------- 7:A`V ----------------------- Contractor's Name --------- - 7_b_:_____, ------------- Phone ----------------------•- ---------- Installation will serve: Residence Y�Apartment House E] Commercial E]>Trqiler Court Ej Motel E] Other ❑ Number of living units: Number of bedrooms 4- Number of baths Lot size ------- 7- ---- X ----- / --- J_ Water Supply: Public system E] Community system E] Private R/Depth to I Water Table -4-ff. 10.1 1 Character of soil to a depth of 3 feet: Sand 0 Gravel [] Sandy Loam E] Clay Loam E] Clay 0 Adobe 0Hardpan 0..Y Previous Application Made: Yes 0 No R( New Construction: Yes El No Ef FHA/VA: Yes E:1 No 2"' TYPE OF INSTALLATION AND SPECIFICATIONS: 41 (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we;l --- 1�? ....... Distance fro Fn f9undation --- 7"-- lq4t e r i a I W No. of compartments ------- --P — ----------- - - ----------------- Capa . Disposal Field- Distance from nearest well --- 1140f Distance from foundation --- A_!t --- Distance to nearest lot line` of lines-- _Length of each line---- of french ..... c25/ -'r - ------- Type' of filter material- _SPTZC� -%Wfh of filter material ----- /df --_____.__Total length ------- 41-0 - ----------------------- it: Distance to nearest well ------- / ------- Di,fanc f f onclaf ion --- Distance to nearest lot line, --%J-/ --------- &rom ( � 1� t 4 'Q� Number 6f pits ------ I ---------- Lining matem& Lin �ize: Diameter ------ Depth.__ ------ A. VIX Cesspool: Distarfde from nearest well ----------------- Disfance-from found.3tion foundation____________ -____. Lining m=afe1qr ------------------------------ -------------- Capacity-. --------------- ---------- gals. Size: 9;ameter ---------------------------------- '-.Depth ------ ------------- ----------------- Liquid Privy: Distance from nearest well'__________________________ _____________________ Distance from nearest building______________.___.____ -------- ❑ Mstance to nearest lot line-__________________________ __ Remodeling and/or repairing (describe): --------------------------------------------------- 0-1 ----------------------------- ----------- I ----------- ------------- I ----------- ---------- k, -------------------------- - ------------------------------------------------------------------------------- ---------------------------------------------- ---------------------------------------------------------------- ---------- : --------------- -------------------------------------------- --------------------------------------------------------------------------- ---------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- - . , _; ------------------------ ! --------- - ----------------------- I hereby certify that 4have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ------------------------------------------- ----------------------------------------- - ------------------------------------------------- -------------------------(Owner and/or Contractor) By: ----------------- _ ---------------------------- --------------------------------------------------------------------------------------- (Tif le) ------------------------------------------- ------------------- (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 APPLICATION ACCEPTED BY--------------------- --- -------------------------------------------------- DATE------------- REVIEWEDBY--------------------------------------------- ---- ----------------------------- -------------------- DATE---- BUILDING PERMIT ISSUED ----------i-------------- -- -- ------------------------------------------- DATE Alterations and/or recommendations---------------------------- ------ --- --------------------------------------------------------------------------------------- ------------------------ --------------------------------- _ ------------------- -------------------------- --------------------------------------- ------------- -------- --------------------- ------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- ----------------------------------------------------------- ----------------- ------------------ -------------------------------------------------------------------------- -Z ------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- -------------- ----------- ------------------------- ----------------------- -------------------------- - ---------------------------------- FINAL INSPECTION BY:----------. ------ ---------------------- ----- Date ----------- -------------------- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M - Reviseci 1.57 F.P.170,