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rQr wrFICE USE: ----------------------------------------- -- --- APPLICATION FOR' SANITATION PERMIT Permit No. � _ - __-- ------------ ---------------- --- ----- (Complete in Duplicate) -- ----- ------------- This Permit Expires 1 Year From Date Issued 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 w6 Co y �in � /J a ( 549. , ZAP HPoI> JOB ADDRESS ANN Lq5CATION-ID� A_LHP� ' ------------ 00 ----- � ----- TIS-R _R� Owner's Name �. R�� A-14 --- -------- Phone------------------------------------ Address----------- -----------------------------------Address----------- Qx _ .6_p_ ` -R N- - - ------------- ----- aux Contractor's _ M- - �� --- Phone----------------- Installation wilh`serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other f DVPI-F-� Number of living units Number of bedrooms _ --plumber of baths ---- Lot size _-.__. ___ __ _d_ __r_______________ I A Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -- _ ft. Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made *(If yes,dote--------------------) No jj/New Construction: Yes EL–AIt ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance)from nearest well--- ____ Distance from foundation---------Q......Material---- `IT �_-.. No. of �¢partments------ $ize__ _X1_a-__}(____`liquid depth____-XX�.,--..Capacity.... ra_Q Disposal Id: Distance,from nearest well_-50--_-_Distance from foundation-----L0-------Distance to nearest loft line----- Numbe of lines____________I- Length of each line_______---75-----------.Width of trench.-----_-3-G i r-_______-____ 00 1 Type of filter material___- --C/��_.Depth of filter material-------/ ---------_Total length----------- ________________ e # Seepage Pit: Distance,to nearest weft_-------------------Distance from foundation-------------.-----.Distance to nearest lot line__-___________-__ ❑ Number of pits---------------------Lining material----------.------------Size: Diameter-----------------------.Depth--------------------------------- Cesspool: Distancefrom nearest we}i------------- ---Distance from foundation-------------------.Lining material-------------------.-_-_._________-__. ❑ Size: D�arneter- - -------------------------Depth---------- ---------- =-------- Liquid Ca acitY' ,. gals. Privy: Distance fromnearest well___��'------------------------------- -----Distance from nearest building------------------------------ --.-.-----. Distance to nearest lot line ->- �---------------------- - ------------------------------------------------------------------ ---- ---------------------- - - � , Remodeling and/or repairing (describe):______ } '_-_- --___B -R00—M_-__-_VIV17-- --_�-.____- -------------- .? i'k=E - `- ---------�X_lSTM!�=7----..5-,t -- ��M------`Z'�-------- O�--------�F-F-r- --J n� _ 1 _�Q_ __' - LATilivc-comm tv1 y-------t�1ATp i� =:F ��.R_�� -�! 1-S--------�� '�� I herebycertifyAat I have re afed thisyaAplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and gulations of`the Sen Joaquin Local Health District. (Signed) .l� �1r� 9 , --- - - ------ ---------------------------------------- --------------------------(Owner and/or Contractor) Plot Ian, s owin size of lot location of system in re afion`to wells buildin s-etc., can be laced on reverse side ( P g y 5 , P .) --- -- . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-._� R -0---------------------____-_-_----�-------------------- - -- -------------- DATE-------�--/d------ S` ��-------- ---------------------- REVIEWEDBY----- --------------------------------------------------------------------- - --- ------ DATE BUILDINGPERMIT ISSUED--------------------- --------------------- --------------------------------------------------------- DATE------------------------------------ Alterationsand/or recommendations------------------------------------ -------------------------------------------------------------•--------------------------------------------•------------- ----------------------------------------------------------------------- ---- j = ---------------------------------------•----------------- FINAL INSPECTI n --. - Date -��--Y✓-�----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT t 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.C Q. S