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5".) APPLICATION FOR SANITATION PERMIT Permit No. _49A-3 (Complete in Duplicate) Date Issued -------••-------------- Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and insfaff the work herein described. This application is made in compliance with County Ordinance No. 54 . l• t --- -- -- - -I•- -- . - ----------- JOB ADDRESS AND—LOCATION �= r c Q ------------------ Owner's --�-----`Owner's Name_____ --------•--••----- ------------------------------ Phone-- � Addre • /---/- --Z----�---- - -- -- , ------ ---------- --------------------- Contractor's Name------•--------•-----•--------------------✓__-.__Q ,Nta' -----`�-- �3- a ---- tt Phone49 Installation will serve: Residence EJ--A--partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I_--_ Number of bedrooms Z__.. Number of baths ._/___ Lot size ------- ------------ --------------------- Water Supply: Public system ❑ Community system ❑ Private epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ . Clay Loam ❑ Clay ❑ Adobe E3-14ardpan EJ 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 within 200,feet.) tiG.Ta Distance from nearest well ______Distance from foundation_'_, ___.___.___..-Material____---------------------------------------------- o. __._____.__.__----.__________.___ No. of compartments- Size---------------------- -- -Liquid depth------------- .... Capacity ield:� Distance from nearest well.... - Distance from foundation____1�_�__.._Distance to nearest lot line___- -. D osal F Number of lines -------- _ Length of each line•_-:_--jT.S_�._.Widfh of trench-------`-�-;�---'-'----•------ W I 4— Type of filter material---Z.__k___ _-Depth of filter material __.______l40_/...Total length------,-!'_j7�_----__._ Seepage Pit: Distance to nearest well_.--------__..-_-_____Distance fromfoundation--------------------Distance to nearest lot line_____________-.- 1! • ❑ Number of pits-_---------------------Lining material-----------------------.-Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from'foundation....................Lining material____.-___________._.__--______ + ❑ Size: Diamefer---f---- ----------- -- ------.Depth--------------------------------- ------------ -----Liquid Capacity----------------------------gals. 3 Privy: Distance from nearest well___________________________._._____.__:----------Distance from nearest building--------------------------------- ❑ Disfance jo, nearest [of line-------------------------------------•----------- -------------- Remodeling and/or repairing (describe_----------_-------_----------------------------------------------------- �,. . ----------------------------------------I--------------------`----- --------------------------------------------------------------- --------------------------•-----------•---•------------------ ----------------•--------- ------------------------------------------------------------------- I ----------------La ----------•----------------•------------------------------------•---------------•-------------------•---•--------------•--•-----••------------------------------------------- ----------- ------ ------------------------- I h eby certifave pre ed this application and that the work will be done in accordance with San Joaquin County ordinances, ate lrues an a ulations of t San Joaquin Lo I Health District. (Signed)-------•--- -------------------------•----------- ------- ------ ----- --- -- ----------------------- ------ --------- Ow Can acfior) By:-_------------- � (Title)--- L -- -- . - ------- --•----------- (Plot plan, showing size'of lot, location of system in� lation to wells, building etc., can be paced on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - ------------- DATE r REVIEWED BY { -- - -- - ----- DATE �` --------------- BUILDING PERMIT ISSUED--------------- ' --:----------------------------------------------------- DATE------------------ rsl-y . ------------- Aterations and/or recommendations:_ --------------- --------------- --------------•--------------------------•-------------------,----------- ; ------------•----------------•-------------- -----------•--------- ---------------------------------------•------------------------------------•-----------_------•---•----•--------•--------------- ------------------- --------------•---------------------------------.------------------------------- - _..-----------------------------------------------•--------•-••--- ---------------------------------------------------------- --------------------- ---------------- ------I- ------------------------------`---------- i FINAL INSPECTION BY: Date • /'. J J • I 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 ES--9-2M 1'5446 ATWOOD 12-Sad 6.