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10114�� I ' APPLICATION FOR SANITATION PERMIT Permit /.` .. ` (Complete in Duplicate) /0 Date Issued --- Applicaa-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 ompliance with County Ordinance No. 544. - - ---------- JOB ADD SSAND L Owner's Name----- --------R ------------------ - - - - --------------------- --------- Phone------------------------------•---- Address - ------ ------- Contractor's Name-------- ------ !_--------------------------- ------------------------- --- Phone2�..k---_-L,B_2 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _ �D�' -____ Number of bedrooms __ ___._ Number of baths ._�... Lot size _________ ��e.d_..______-____ - Water Supply: Public system. ❑ Community system ❑' Private [Depth to Water Table 4?ft. Character of soil to a depth of 3 feet: Sand ❑ Gravei ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a---Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes 2"N' o ❑ 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 fr�gm foundation__;,f4_--_-.-,/A Material_e�_Cr____1• ----.-_---- No. of compartments-------- - --- -____-__ � � -- depth----- ---'Q--------------Capaci#Y•--��--��----- Disposal Field: Distance from nearest well__ _._._Distance from foundation---a�A__..__------Distance to nearest lot line._,�1�______. Q� Number of lines Length of each line ---rf--`- -- ------.ii--- .Width of trench `; Type or filter material-4c_A64J,k---Depth of filter material-..__-_-/9---------Total length-------1 5 Seepage Pit: Distance to nearest well__l.4_�_----------Distance f om fognd tlon____C___.._._.___.Distance to nearest lot line__/d_____.. �� Number of pits________--_.____Lining material t_ . e: Diameter___�J.............Depth____ _�S.__�________ _______ 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 ----------Remodeling and/or repairing (describe);----------- ---------- -----•--------- ------_- ----•---------------------••---------------•-- -----------------------------------------•-..--------- -------------------------------------- ------- ------- - - -------------------------•---------- ------ -- ------------------------•------------------------- r ______________________________.-_____.-________.___________________-________-___-______.____________________________-_.___.__.--___-__--________________-__.___-.__.._______--_____-____---__-____.___--_..__-_________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County R ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Signed}--------------------------••----------------•- --- --------------------- - --- --- -------------------------- ------ - - ----- ----------------- -.{Owner and/or Contractor) '{ } By::.... �C �. r ------------------••--••-----------------------{Title}��#- �------------- { '(Plot plan, showing-size of lot, location of syolm in relation to wells, buildings, etc., can be placed on reverse side). G� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ----- ------------- --- ----- -----------------------------------------•------------- DATE------. ---------- REVIEWEDBY------------- ----------------------------------------- --- ------------------------------------------------------------- DATE -•----------t---._... BUILDING PERMIT ISSUED-------------------------------- •--------------------------:_ DATE---------------------f --------------------- Alterations and/or recommendations -----------------•-•--•---•------------------=---------------•-----•---------------- -------------------------------------- - •- ------------------- ---------- ------- ---- -- -•------------------------ ---- FINAL INSPECTION Date l_C -` `�G - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130'Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California „ ES-9 745446 ATWOOO