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.�. y...r.�F FOR OFFICE USE: -1 ------------- - -0-0--- P ��9 2 -z/,-$7 s ,'+cU APPLICATION FOR SANITATION N PERMIT Permit Na. ._._..._._.735--_-.. --� ---'-- � (Complete in Duplicate) Date Issued f- x -------------------- --- ------------ ---------- -- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance wih o my Ordinanco No. 549. C JOB ADDRESS AN ION. - .:-. W- 5 .. h r Owner's Name [ ---- --ull-A---------- ��_ ---------------- -- Phone- - Address----------------- - ----�--- / ------------- - ---------------- --- �, F 4,Contractor's Name �L(-'5------------------ Phon .Thly/---- Installation will serve: Residence$ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i t Number of living units: Number of bedrooms ___Number of baths -j-_-__ Lot size ---------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table4Q- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: (If yes,date---.---- ] No% New Construction: Yes 0 NoK FMA/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------.----____-__------.-----.- ❑ 1-4S�6�� No. of compartments.-------------------------Size-------------------- ---Liquid de th__-.-.-_--.-----_ Capacity Disposal Field: Distance from nearest well-_/00.41`QeD1stance from found ation_-/-Q..........Distance to nearest lot line--s l---. Number of lines---S-IV—V'----------------Length of each line___. 10FTF Width of trench.---�.�-�r------------------ Type of filter material_-R-$..��____Depth of filter material--- - ------------Tota! length----, -Q---------------------------- Seepage --------------- ------Seepage Pit: Distance to nearest well__&__Distance from foundation-4- --C-----_._.Distance to nearest lot line- `.--.-----_ Number of pits - —------Lining material__ C��r...Size: Diameter_ -- _-_ �Q � --Depth----. -------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------------------- FJ Size: Diameter--------------------------------------Depth---------- ..------.-----------Liquid Capacity-.. gals. Privy: Distance from nearest well----------------- -------- -- -------------- from nearest building------------------------------- 11 Distance to nearest lot line.- -------- --------------------------------------------- Remodeling and/or repairing (describe=-- ---- OF------------ --------------------------- --- ---- ---- ---------- ------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------------- I hereby certify ffhafve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawules and regal ons of the San Joaquin Local Health District. (Signed)---------------------- -- ---_--(Owner and/or Contractor) BY=------------------ ... . -A------------ - -- - ------------------------------------(Title)--- --------------- ------ - ------- (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be pla a on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- DATE l Z.3 (p �q REVIEWEDBY------------------------------------------------------------------------- and/or ---- ------------ - ------------------------------ DATE------------- ---- --- ---------------------------------- BUILDING TD -------------------------------------------- Alterations recommndations: --li -- E - -.-- ---------------------^ �.] _ ---------------------------------- ------------------------------------------------------- --- ------------ ------------------------------------------------------------------------------------------------------------- ------------------- ---- -------------- - -- ----------------------------------------------------------------- ---------------------------------------------- -------- FINAL fNSPECTIONDate..Ia- BY:--------. .- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.