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nppilca-ion is nereDy mase To Tne oan .luaqum LUt.ai I ICia1l11 vu111a.1 1U1 a PVI 1111 1U�.wIDIIU.l ullu Illolan Inc w 1n nclonr uua411ucv. This application is made in compliance with County O,rdinlnce No. S49. JOB ADDRESS AND LO4 CATION. . Owner's Name r r.,.. ------ ------------------ Phone...... Address.- !.. - = ------------•----------- ----------------------------------•------ Contractor's Name--- -•------:-------- -- • $ -- --------------------------•----------•-----------------------------•------------ ----- Phone----------------------------------- Installation will serve: Residence T.partment House ❑ Commercial ❑ Trailer Court ❑ M��jotel E] Other ❑ Number of living units: ...,Number of bedrooms _4.-. Number of baths _-4._ Lot size _�11-__ ___ .-------..............N — Water Supply: Public system V Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe &0 Hardpan ❑ \ Previous Application Made: Yes ❑ No V New Construction: Yes B/No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 feet. Septic-Tank: Distance from nearest wel ..._. ...J_Distance fro fou anon_1 --------------Materiil__________ -------"_.._._____±_..i._.•_-__._. No. of compartments-. _____________ ize_ ---------X2_ --_-Liquid eepth__.,_. ._.Capacity___ Disposal Field: Distance from nearest well E Distance from foundation!-__ ° Distance to nearest lot line:._.f+------..... Type or filter material;_��f� gh of {filter material-..�� width of trench___.___�__�"__._.________ y Number of lines---------- �__- ___.___..Len th of each line tl - - e t ial-...- -Total length-------------A" "- ----------- YP P 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-_._____.._.________-_______._----_. ❑ 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)--------- --------------- -------------- --------------------------------------------•----------•-------•--------------------•-------- --•- -------- ---------------------•--•--•------------------------•------•---------------------------•------••-----------------------•-------------•-•-----------------•-------------------------------- - I hereby certify that I.have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) _...... ------------------ --------------------------------------------------------------=--------(Owner and/or Contractor) ----- . 1 F _" - �8 , :t := - -------------- [Title) ._� _ . (Plot plan, showing size of lot Vocation of system in relaiion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY�.- =• - ----------------- - ------------- --------------------------------------------- DATE_ -- ----------------------------- ----------- REVIEWEDBY---------------------------- ------------- - DATE_. ---- BUILDING PERMIT ISSUED. - DATE Q-------------------------------------- Alterationsand/or recommendations:.---•-•----------- ------------------------ ----------------•-------------------------------•-••--------------------------------- -----------------------------------------------------------•--------------- ----------------------------------------------------------•--------------------.-_..._- ........................................................ ---------------------------------------------- -....................................... ----------------------------------------------- ------------------------------------------------------------------------------------ Y: --------------------------------------------------- - -- -- --- --------------------------- -------------------------------------- •--------- - ----------- ----•----- ------•-------------------- FINAL INSPECTION BY:----- C><,•- - ------------------------ Date.---- --------------------------------------- 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 E5-9-2M ia5n46 ATWa90 12=54