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t y (PLICATION FOR SANITATION PE; 7T Permit No. __.f[.. _`_ •__. ' II (Complete in Duplicate)' i' Date Issued ,I Applica+ion is hereby made to the San Joaquin Local Health District or a permit to construct and install a wo he i e ib This application-is made in compliance with County Ordinance No 49. �� JOB ADDRESS AND IA 0O .l,p : - - --•--• ---, ------•S- wner's Name......... . Phone Address - X- ................................... Contractor's 'Name.............II-• ----- W - Phone ------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .a1 Number of living units: _/.... Number of bedrooms _./._. Number of baths 1... Lot sizey f --4,�................. ......... Water Supply: Public systef�m Community system ❑ 'Private ❑ Depth to Water Table��ft. Character of soil to a depth of 3\fee+: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam [] Clay ❑ Adobef Hardpan ❑ Previous Application Made:i Yes ElNo New Construction: Yes ( No ❑ ` TYPE OF INSTALLATION AND SPE IFICATIONS: / (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest w•ell�y-�--Distanc Distance foundation--- .______.M i�rial____>�,¢,�� - - No. of compartments-..-.----------------Size�-�!�.�-liquid depth- ._.__. ,7..._..Capacity---�---G---0.__- I l Diel Field: Distance from nearest wellrYt- Distance from foundation_ L?_._.__..Distance to nearest lot line-----��7?Num _-- S. ei` of lines------/-------------------- - Length of each line....... ............Width of trench.---.._��11 Type .._____-_••-•-- Type os' filter materia - ____-_ --_Depth of filter material____.._ ._...__._Total length-__.-_____��_____________________ II ` Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- .1 ❑ Number of pits----------------------Lining material-------.---_---------.Size: Diameter........................Dept h---.-.-.---.-------------....---- cesspool. Distance from nearest well.................Distance from foundation---.----------------Lining material----------..__..-__-_.________------_. ❑ Size: Di ameter._ _-------------------Depth........................--- •--------...Liquid Capacity............................. gals. 4 Privy: Distance from nearest well.--_.,--- ------------ ---------------Distance from nearest building----------------------------------------C ❑ Distance to nearest lot lirse.----------------------------------------------- ------------------ �Remoclel�inr repairs g (describe):_,-, - __--- ,__- . �"=== -_-- --�---•- ------ . .....:.......:.....•-------•-•-•------.....__.._.....•-------•------••------...........---- -- ----.... ...-•----••. -- ......._....._..-- ----------------------•--•---- ' ....... •---_..____-__11..._..._....____._..__.................-_-___..__._______--__.______---_-.-.__ __.___.___._.__.__..__.._....___...-_...--.-._.._____..._.__....__-__...__________----------____ �I hereby certify that I jhav prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State , and,, s d regulations of the San Joaquin Local Health District. (Signed) ---- -------------------------------------------------------------------------------------------------- j Owner and/or Contractor) ... ... --------------------------------------------------------------•---------••--•••--•------ -- ; ---------------------- .. .... plan, showing si of lot, location of system in relation to wells, buildings, etc., can be pl cad o verse side). .;I. FOR DEPARTMENT USE ONLY APPLICATION REV EW ED BY. ACCEPTED BY. •-•-•- DATE - .. - 1...-------- ----•...... ................ ••---•--•_...._ DATE-_ _.� --- ------------- BUILDINGPERMIT ISSUED'. ---- --------------- ---------•------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations---------------._...------------------•-,-•---........................................-...--..................................• •-••......... ._ ---------------------•--......_...-_I.......----------•---------------/------...._.�. ....... ------ ?°�1� y� ................................. --------------------------------------------_ ---______________-__-__._..-----------------------------------------------.y________-__________-___�-------- ---_-•_____._-__-.....----------------------------------------- .. A- �P Yc��l{� rcas. ... - ------------------ ------------------------------ ----------------- -------------------------------------------------------------- L 5......---�- - -- --- �i FINAL INSPECTION BY:L---�-------- ------------------ ------------ Date-----5"--- ------•--------------_- .......... ,1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet Stockton, California �IN Lodi, California Manteca, California Tracy, California E5^9• 2m 145446 ATW009 12-54