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FOR OFFICE USE: til --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .._ ..l... Ij� --- ------------------------ ----------------- (Complete in Duplicate) Date Issued .__._ _�4� ---------- _--_ -_-_ _-- -----. 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 Ordinance No. 549. rho L �_r4� JOB ADDRESS AND LOCATION.__`�__�/___h✓/� ..___i"_4.... .___I...�� ''_'---------------- Owner's Name---�p----•---1 AL—MER------------------4-a-Q ----- -------- Phone----------•-•--------•-------------- Address--------------R-rF•.�---�---r'� ae, 'Z 1 � - mT -- ----------------------------------- Contractor's Name-c'e -G ✓ 7 /C Phone ----------------------------•-------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _J--- Number of bedrooms -____f'_- Number of baths __(_____ Lot size -----.lpG_-_x___f� _____________________ Water Supply: Public system ❑ Community system �rivate ❑ Depth to Water Table ._14_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------_,---.----) No New Construction: Yes E3-1�o ❑ FHA/VA: Yes ❑ No [jq TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep�tiIc'/Tank: Distance from nearest well_.,.^®I--_Distance from foundation-1b. Material._IT-'rW405C-'4 _______.__._._______.. L� No. of compartments__-_1.---- ---- _-.__Size------c3?(4_'V_/---,---Liquid depth_,%---_-__----.-_.-----Capacity.... . _ Disposal Field: Distance from nearest well-,6-0---------Distance from foundation-__ _____.Distance to nearest lot liner_C._.__. Number of lines____/_____________ ___________Length of each line__+,$e20------------------Width of trench----%Z9_-`-:____---__-__-__-- Type of filter material_'TA4-k_---------Depth of filter material---/9--__`_----------Total length---------46_o---/____--_-__•.___--__-_ 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------ --------------------------- -------- -------------------------------------------------------------------------------------------- Remodelingand/or repairi (describe):------------- ----------------------------------------•-------------------•--------•-•----------------------------------------------------- ------ ---•--------•---------------------------------------------------------------------- ------------------- --•----------------------------------------------- ---------------------- ------- ------------------- -------- --------------------------- --------------------------------------------------------------------------------•------------------•------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an re ulations of the San Joaquin Local Health District. (Signed)----------------------- - -- - --------------------------------------------------------------------------- (Owner and/or Contractor) By:---------------------------------------------------------------------------------------------------------------------------- -------(Title)--------------------------------------- --- - --- ------- (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 1- APPLICATION ACCEPTED BY----------- -'_R_ -0- '--------------------------------------------------------------- DATE------ ---------- REVIEWEDBY--------------------------------- ------ ------------ ---------------- --------- --------------------------- --------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------- -------------------------------- -------------------------------- DATE----------------------------- -------------- --------------- Alterations and/or recommendations--------------------------- --- ------- ----------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- --------------------------------------------------------------•---------------------••----------•---- ------ -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------- -------------------------------------------------- a ----- . 1 - '` r -- /� -------• ------------- ------------ - FINAL INSPECTIOf�6 -�- / ? r"----- �� Date - ----------------- 9- �`� 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.