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yrrll,C Uor: ---------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete"in Duplicate) This Permit Expires 1 Year From Date Issued Bate Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and in st I the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AlON__ Q - ------ -Zd - --- -- - Owner's Name_ --- �,�{� -•--- -N_ _A4_a1�'�, .PR---- - ------ -------------------------- ------- -- Phone----wa-w ef's— Address � �. ----L'--��- A------- Contractor's Name------------ /}l��l_S S-O_/'rS__ /A C---------------- ---------------- Phone___ Installation will serve: Residence [] Apartment House ❑ Commercial ❑ Trailer Court K Motel ❑ Other ❑ Number of living units;.4,0_ Number of bedrooms.r440 Number of baths4Q_ Lot size j � _ Wafer Supply: Public system E] Community system [I Private Depth to Water Table 70. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q( Hardpan ❑ Previous Application Made: (l#yes,date.-------------------) No X New Construction: Yes ❑ No X. FHA/VA: Yes ❑ NoX 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 ..___-__________ _ _.._- ❑9K0-PeN6No. of com artments- p --Size_ - ------ ------Liquid depth----------------- --------Capacity Disposal Field: Distance from nearest well SFJ__.--Distance from foundation-"lQ f fA ---------Distance to nearest lot line---7, -••- Number of lines__. ¢-.�[- _-- Length of each line___,-- Width , if 1 �,� dth of french..-_2,of filter material--- _ --_Depth of filter material ___---g--_--------Total length--------24!_ Seepage! Pit: Distance to nearest welL �-------Distance m f ndation ��-�-_--.Distance to nearest 1 t line�._ c�`r-_ l Number of pits--_.?!__--...____ Linin material_-�-.Size: Diamefer__41-_ - g Deptn_. ----------------- Cesspool: Distance from nearest well - Distance from foundation_____ _ Lining material--------.-.._-.___.---_ ❑ Size: Diameter. --------Depth--------------- -----------------------------------Liquid Capacity------------------------- gals. Privy: - Distance from nearest well------._---------------------------- '- Distance from nearest buiidin 9 ❑ Distance to nearest lot line.____._____..._ Remodeling and/or repairing describe):____- d ----------------------------------- ------------------------------------ �#------- --------- ------------------------------------ --------------------------------------------------------------------------------------------•-------------------------- --------------------------------------------------------------------------------------- I hereby certify that a prepared this application and that the work will be done in accordance wifh San Joaquin County ordinances, State laws, d r es and regulat' s of the San Joa n Local Health District. (Signed)-----------•-------- r � ..... - •------- ---- - Contractor) -------- -------------- $Y= --• (Title) r r ne and/or (Plot plan, showing size of lot, location of system in relation to ells, buildings, efc., can be placed6n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- .------- - -_" - ---- ------ --------------- ----------- ----------- ------ DATE----------- REVIEWED BY---- ------------------------------ -------------------------------------- -------- DATE---- - ------------------- ------------------------------------------ BUILDING PERMIT ISSUED------------- _ ---------------------•------- - ?.A. E Alterations and/or recommendations:-- ------------•------- �'t --------- ------ --- - - -j'il!�tl�'� ------------------------------------ - - --------------- FINAL INSPECTION BY:.. ........ ----------------•- ---- Date------2--y O —6a I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 S.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy, California F.F.0 O.