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�47 . .— APPLICATION -FOR SANITATION PERMIT Permit No. U (Complete in Duplicate) q/ Date Issued Q�F�S_�_-- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and -� wor erreein described. This application is made-in compliance_With County rdinance No. S49. JOB ADDRESS AA LOCATION___ ' + � ------------ __ __.__JJ__ _-_ Owners a--•--- 4- er R ------ Phone------------------------- -------- - -------- - -- IL ----- - Phon ------ 7� 6 Contractor`s Installation will serve: Residence RI/Apartment House ❑ Commercial Trailer Court M �.r ❑ ❑ Motel Other ❑ Number of living units: _f___- Number of bedrooms a•e7-_ Number of baths .A6ot size -----�_._- ----__ --------------------- Water Supply: Public system ❑ Community system ❑ Private 99pthto ater Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam E] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes a i— ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well+ _--Distance from f njdation_ __ P- ---- erial______________________ o --------- ------ --- No. of compartments-- -------------------Siz*Cf -- ------ ---Capacity_ ----- Liquid depth_ --- rDisposal Field: Distance from nearest well -- - _Disom fo dation___ 4V------ to nearest lot line_ Number of lines___ -----__---_ -Length of each line--- _D._-�___ �i /! Width of trench.__Z ---------------------- Type of filter material C- Depth of filter material___-. .._.._ . .Total length__.."'Z_-0----- 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------------------------------------- r_1 Size. Diameter--------------- �-� -------------- ---Depth -- ----------- --------------- ----------------- ------ - ----- Liquid Capacity- :-------------------------gals. Privy: Distance from nearest well___________________ __ ----____:____Distance from nearest buildin ❑ Distance to nearest lot line----------------------------- ----------------------------------------- --------------------------------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- -------------------•--------------•------------•--------- -----•- -------------------------------- --- -------------------------------------------------------------------------------------------------------------------•----------•------------------------- ---------------------------- 1 hereby certify that I have prepared this application and that the work will be done in actor ante with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----------------------------------------- By:----- --------------------- --- Contract Title)_(Plot plan, showing size of lot, location of system in tela+ion wells, buildings, c., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------___---------------_--- _ � ---------------- DATE_.------ --- j -------- ----------------- REVIEWED BY ---------- BATE f BUILDING PERMIT ISSUED------------------------------------� ---------------------- -------•-•--------------------------- DATE----- ------------------------------------------------------- --Aterations and/or recommendations:.................. ._ ---------------------------------------------------- ra (LI) FINAL INSPECTION BY: -•-•--------- ---------------- Date---------,�--•-fl � s I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet Stockton, California Lodi, California Manteca, California Tracy, California E$-9-2M 145446 ATWOOD" 12-54