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F FOR OFFICE USE: -------------------------------------------------------- , ___________-________________ ___ APPLICATION FOR SANITATION PERMIT Permit No. . ..� --- (Complete in Duplicate) -- - �-�- Date Issued _/D_�_.�L-__� --------------------- _-_- ----. -_-.--- 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 made in compliance with County Ordinanc/e No. 549. JOB ADDRESS ��'�/t��V��D LOCATION _Aff, � _64/--_--2a---_---/Y'Q..'.-.. --,I GV ----L �-----I�IIQSlpp._.�SI L//?_//0��1�j Owner's Name---1FF-V--- -------- �IL---------- ----------------------------------- --------- ---- _. Phone.Q.� � 4or-1D-!_�- Address / 1 --------- �� ---�--------------------------------------------------------------------------------------5 Contractors Name---- -- — - --- -------------------------- ---------------------------------------- Phone--�•2. r Installation will serve: Residence ( Apartment House ❑ Commercial ❑ Trailer Courte ,� Other ❑ Number of living units: --- ---- Number of bedrooms -3---. Number of baths _/---_ Lot s' e ___ —R - _____________________________ Water Supply: Public system E] Community system El Private ® Depth to Water Table -__ _-_ Character of soil to a depth of 3 feet: Sand)Z Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------_-.-------) No X 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.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- F_Xkf>T-/AIC— No. of compartments---- --------------------Size-----•-------------------------Liquid depth--------------------------Capacity---------------------- p _____.Length of each line__.__-Sj_ Distance to t nearest lof line..... ------- Number osal Field: Distance from nearest well__6_t� ._--._Distance from foundation___�__..s Number of lines._--___ -- - -- Depth of filter matenal____.1,7 .__-_ Width of trench._.�r�_______ Type of filter material__.___ _ p Total length___.✓._6 ------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----_.-.-._---.._ ❑ Number of pits....... ......... ...Lining material--------_-------------Size: Diameter---.-------------------Depth-----._..-.--_--.._-.--.__------ 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------ --------------------------------- --------------------------- ------- ---------------------------------------------------------- t .` Remodeling and/or rep7-1airing (describe):__-- 9NIK______�(1_ST/�(Gmt_-.A-�P...._-I-sv----__-LEACH-.-__7W-W- ------- QUT�-F-T�--------T= .0_s----------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- ------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------=-----------}--------------------------------------------------------------------------------------------------------------------------------------------------- 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 regulatio of the San Joaquin Local Health District. (Signed)------- - - __,J ---------------------------------------------------------------------------------- .(Owner and/or Contractor) By:------- ------ -- -'_--_ ------------------------------ - ------------------(Title)------ ------------ --------__ --- -- ------ -------- (Plot plan, showing size of Tot, location of system in relation to wells,.-6aildmgs, etc., can be placed on reverse side). FOR DEP "ENT USE ONLY APPLICATION ACCEPTED BY------ I ' ` ------ ------- ------- --------------------------------------- DATE----fC_ 2 5- ------------------------- REVIEWEDBY------------------------ ---- ---------------------------------------------------------- ------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------- ------------------------------------------------------------ DATE--------- ----------------------------------- --------------- Alterations and/or recommendations------------------- --_.------------------------------------------------------------ ----------------------------------- ------------------------------------ ----- ---------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- LLizFINAL --------------- Date---------/(1 -��-- -- (� _ 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.P.CO.