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FOR OFFICE USS►:, . ., • APPLICATION FOR SANITATION PERMIT Permit No. .. .�2:(�.1! -- ------- }. -------- -------- (Complete in Duplicate) 1 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 ap.Plication is made in compliance with County Ordinance No. 549. /� _ I -- JOB ADDRESS AND LOCATION------��-��__�-_...___.t':(_V_�T�_N..___.._�________________________ OwnersName-------------- ---_--AFE.T------•- I-V.-C/ S----_--_-- ------------�--- ------------------------------------------ Phone------------------------------------ Address--------------------------_75_0_ ------- RC'''S.------A JE-----------M-L-l--t------------------------------------------ ------------------........................ Contractor's Name------ ..... .W IYF—K.... - -- ------ ---- ------------------------------------------------- Phone---------------------------------- Installation will serve: Residence P__tpertment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: _�.---_ Number of bedrooms___- Number of baths Lot'-, ----- /----�------/�?S---------------------- Water Supply: Public system ❑ Community system ❑ Private ET"'bepth to Water Table/Q ft Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Applicatign Made: (If yes,date------ ) No New Construction: Yes�o ElFHA/VA: Yes E�J""No ❑ TYPE OF-INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . Setic nk: Distance from nearest well------5_0__Distance from foundation -.��__ -----Material_ .aNC}�.�_-F---------- P No. of compartments.-_--_, ... `_r LIQ.X�,Liquid depth ;,. Z– . Capacity_jZ O-__- -- . -.Size (A Disposal Field: Distance from nearest-well__,5_Q._ .Distance from foundation----10 .._---.Distance to nearest lot line....,".... Number of lines---------- _._._.___ ..___Length of each line__ .... 7 ....Width of trench.... .......S.�. c Type of filter material __ __--Depth of filter material------.1_.J--------- length_______________ _ _.--__.- Seepage Pit: Distance to nearest.well____-_______________Distance from foundation--------------------Distance to nearest lot line-----.----------- Imo, ❑ 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 t -o nearest lot line----- -------- -------;-- `------------- ---- ----------------------------- Remodeling and/or repairing (describe):----------- � ? fti'1 --tVCT.....0E —6.NE C-).....-:1.<L '_----U _--------•--•------------- - - (�4,1+7ti------C t_1_ _4_t .t? ------0 4t> `r -Q-1 _______________________________________________________________.--.__-_-_.-------_-----_-..--__--_-------__---__-___-__-__----•-_-___-_.------__-___-_-__-____. -_.-.- ..-_-_ _ __-.-_----------- ---- -----------------------------------.----------- _--_ ________-_ --_----.__---_-- -. - _--__------_ _-_- -------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accardance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District (Signed)....I �_ _ _; 1 --- - = (Owner and/or Contractor) By:---------------------------------•--------------------- ------------ ------ ------------ ------------- ---- ------------------(Title)--- --------•- ------ ------------ -- .. ----------------- (Plot ------ --------(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-------T` --------------- - -------------------------------------- 7,11>7 REVIEWEDBY----------------------------------------------------------------------------------------- ---------------------------- DATE PERMITISSUED--------------- ---------------------_- - ----- DATE-------------------------- Alterations and/or recommendations:----------------- - - ------ -------- ----------- -----------------------------------------It----------------------------------------------- ----------- -------- -- --------------- - ------- - ----- -------- ---------- -- ----- - -- ------- - ------------- --------- ------ ------ ---------- -- ------- -- ------------ ------ FINAL .I �j - Date D----------- ------------------ 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 E.H.9 2M 1.67 Vanguard Press