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� I APPLICATION FOR SANITATION PERMIT Permit No. —5-8.99.......... (Complete in Duplicate) �, .• Date Issued Applica{ion 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. JOB ADDRESS AND LOCATION-------2-72?---Camtry---Club,---Stockton----•----------------------------•------------------------------------------- Owner's Name--------. red...Gau.&er--------------------------- ---------------- ----------------- -- -------------- Phone-------------•--•---•-----------•--- Address..----.SAA30... -•--------•-•---------------------------------- --------------_ .----------------------------- ~ Contractor's Name-------oWneY'-------------------------------------------•----------------•------------------------------------------------------•--.- Phone....-----------------•----------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court []• Motel ❑ Other ❑Triplex Number of living units: _-. -- Number of bedrooms .-4_. Number of baths ---3-- Lot size ---5---aar-ez-------------------------------------- � I Water Supply: Public system ❑ Community system ® Private E] 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: Yes ❑ No [ New Construction: Yes g]C;No"❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r ) (No septictank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from-nearest weli--,-.J_0(}....Distance from foundation--.--10.........Material.- Redwood------------------------- $] No. of compartments--------2---------------Size----6xl4,5----------Liquid depth--------4,!.............Capacity---- -Q ----•-• Disposal Field: Distance from nearest well_---1Q_C___-Distance from foundation-.1-O_______-1---Distance to nearest lot line.._.._-------- Number of lines---.-5---------------------------Length of each line....9.0—jg,--30---Width of trench---24------------------------ Type of filter material--_S.T.R-OC10epth of filter material--..-� .--.-..-.--.Total length-----3.0-0-------------------------_ Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material------------------ ----Size: Diameter---------.--------.-.--Depth--------------------------------- IL Cesspool: Distance from'.nearest well-----------------Distance from foundation.-.--.---------'-- Lining material---------------------------- " ❑ Size: Diameter-----------------'--------------- Privy: Distance from nearest well.--- _--- ---------- Distance from nearest building----- -------------- ------------------ ❑ 'Distance to nearest lot line---------------- ----------- ---------------------------------------- ---•------------------------------------------------------------- ,. � Remodeling and/or repairing (describe)=----------- -------------------------------------------------------------•-------•-------------------------------,.-..-------•-----------.._...-.. ... of ItJ ------------------------------------------------------------•---------------------------------------------------------------- -----------------------------------------------------••----------------------------------------------------------------------------------------------------------------------------------------------------------------------- I I hereby certify that I'have prepared this application and that the work will-be done in accordance with San Joaquin County ordinances, State laws, and-rules and regulations of the San Joaquin 'Local Health District. '' 1 (Signed)------------------------•-------------------------------- ----------(Owner and/or Contractor) 4 - -- •------------------------ f (Plot plan, showing size of lot, location of system in relation to wells, building (Tale) -------------------------------------- s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY le APPLICATION ACCEPTED BY-.-.--.----- - ------ - ------------------ DATE-------------Z7.i/`SG ---•------------------- REVIEWED By------------------------- ---- ----------------•---- - --------------------------------- DATE ' BUILDING PERMIT ISSUED----------- ------------ - ---- -- - -------- ----- ----------�---------------=--------------------- DATE------�--------------- -- - Alteration .an /or ecommendations:.------------------------.3-------- 4------ ----- ----------..a-....----- --•-----•---=---••-------------------- _ J/ _h V- -'.�-.-- •' fin% --------- --- ------ I---------f1Aw�-----------------------......---------------- -._.. [[ yr O `TY .- -ice---• - ---•-_------•/_ - _- i FINAL INSPECTION BY------ -------- 1-- ------ ----------- ...... Date. --- ----� � .fit . .... ..---------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South:American Street 300 West Oak Street' 132 Sycamore Street /814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California EE3-2M 145446 ATWDDD 12-54 I -