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rl\ APPLICATION FOR SANITATION PERMIT Permit No. t �, •` (Complete in Duplicate) _ Date #slued l Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein dewW. This application is made in compliance with County Ordinanc i4o. 549. 3D 7 JOB ADDRESS AND LOCATION . ..+ �� / l - = ��. /� -------------------------------------------•--- - Owner's Name RG1 Beni - / � ?fT--------- Phone V�_. _. F Address s"wl�'d olt�r --• -------- --------- _._..-- - "' Contractor's Name------------------ -------`-„ �----- !___ � f__c�t7 - �_�;11,---, !fes-:---- Phone-. �Q Installation will serve: Residence X Apartment House ❑ Commercial E] Trail r Court El Motel 171Other j] �+ / r r Number of living units. .�`_:-- Number of bedrooms ..Y. Number of baths -_('_-: Lot size -_ ----------- -----------------.--:-.... Water Supply: Publics stem y J!I-...:Community system ❑ Private ❑ Depth to Water Tablec;;L?k ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Cj Hardpan 11 Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No [ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation-_______- _______..Material-------_-------------------:--.-_._: EaiRing No. of compartments-------------------- ----Size--------------------------------Liquid depth--- --••--------------- Capacity --------- -- -•- Disposal Field: Distance from nearest well Distance from foundation---_-------------- to nearest lot line................. ExUiting Number of lines-----------------------------------Length of each line------- ------_-_ ---_ Width of trench---------------------------------- �;' Type of filter material_•-_____ ____-___'Depth of filter material _________________Total length------------------------------------------ Seepage ___:_ -_-_----_. _--_- ___-- Seepage Pit: Distance to nearest well X011140._....Distance from foundation-_. O=......... to nearest lot line 11 ; ME Number of pits_____-a.__-_____ ___Lining material.-.Ce__Rrlj*ze: Diameter....331t---- Depth_._ 5--- 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- ----- - - ----- - -------- --------- ----..............--------------------- ---- --------- Remodeling and/or repairing (describe)c---------au,)"J]alE,T qAt-__to-_4 inktgo 'AY04;ID*_*.........-- ----- --•--•- ------- -------- -------- ---•--- ------- ------ ------- ------ ----- ---- I hereby certify that I have prepared this application and that the work will be stone in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Y (Signed)------D• _At•..... ------- ... -- -- - -----#----- - ----- ---------' ------- ---- - BY. --- - -- ------- ..---- ' -------- - --- (Title)---- 94 t tor------------------------------ (Plot p! , sh ing size of lot, location of system i relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. --------c----/---- --- ---- ------ ---.... ...----- -------- --------• DATE -------- -------• ------- REVIEWED BY- -•------- ---- -------- ------- ----------- DATE.•. e---- 4.�. .. BUILDING PERMIT ISSUED________ ____________ DATE._ ____ --- ----- ..._ Alterations and/or recommendations:----•------- -------------------------- --- ------- ------_- --- -.-. _.._.. •--- . . ------ --- - =------•--- FINAL INSPECTION BY:------ - Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 .-