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J APPLICATION FOR SANITATION PERMIT Permit No. /Xv (Complete in Duplicate) Date Issued -------------1-"___.- ` 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. 544. 2Ij�.4r ---- --------------------------------------------- JOB ADDRESS AND LOCATION______ _.__ _ Phone------------- -------------------•-- Owner s Name----CCX-- •----- - -- ----------------------------r --------"-------------:--------------- --------•--•----•-------•--------•------- Address.---------I ---• ------ -----•---------- - ' A Contractor's Name = Installation will serve: Residence Rj__Aopartment House ❑ Commercial ❑ Trailer-Court ❑ Motel [I Other ❑ Number of living units: ___.1__ Number of bedrooms .___,1-Number of baths _/____ Lot size ----S�A-------Y---1p... ------------------- Water Supply: Public system �ommunity system E3Private ❑ Depth to Water Table ft. � -n� Character of soil to a depth of 3 fee+: Sand ❑ Gravel E] Sandy Loam [-] Clay Clay Loam Clay ❑ Adobe lam-r,and�pa ❑ Previous Application Made: Yes ❑ No Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tian f Distance from nearest well-----------------Distance from foundation'____ _____________ No. of compartments Size Liquid depth- Capacity Distance from foundation_____-- ' isposal Field: Distance from nearest well. _. _ ..__.._ 10Distance to nearest lot line______ ____•.___. ----------7-0-- -----.-------Width of trench------ __ Number of lines---------- -_.. ... - _____Leng+h of each line Type of filter material------J--- ------- ---Depth of f'sIter material-----)_"jr-----------Total length---_.----`J'--V----...------------------- Seepage Pit: Distance to nearest well =-"---Distance mio dation----J"�.......Distance to nearest lot line--- - "_--- Number of pits-_------I---------.---Lining'material--- Size: Diameter .------.Depth-- za"-- n Cesspool: Distance from nearest well___u':-__1_-_6istance from foundation-----_--------------Lining materia--------------------------""--gals. ---:De th------------------ -- ----------------------------Liquid Capacity----------------------------g ❑ Size: Diameter---� ---- -------- -------� �- p - Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_._..____.--"""------------------------ _ Distance to nearest lafi line_..___----------------------- ------------------------------------------------------- -- -------- ---------- ""-"`""--- ---------••--------- ❑ Y -------------------•-----•----"•---•-------------------•----- Remodeling and/or repairing (describe):--:--- --------------------------- -___ •-------•---------"---------------------- ----- ------•------•------ 1 --------------------•-------------------------------: __ ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Contractor) R (5li d ne 9 ). fi le] --------------- ---------------------- (r+ = ----- ----- -------- (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 --- DATE----- � - APPLICATION ACCEPTED 8Y___________________ DATE------ __CC REVIEWED 8Y DATE------ -------- -------- ' -------------------- BUILDING PERMIT ISSUED---------------------------------- ------- -------------------------- Alterations and/or recommendations------------------------ ------------------•-----• -------------------------------------- •---------------------- ------•----� - -------•---------- ------------------------------------- --------- -----•----- _ Date -� --- ------ FINAL INSPECTION BY:-__.__.. .............. - -------- ------ ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y. ES-9—zM 14544.aT -- 1Z...