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41 I ` • APPLICATION FO,__,,.SANITATION PERMIT } [Complete in Duplicate] Date Issued _____________________ Applica-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 compliance with County Ordinance No. 549. �. .oma CD �,,`` sZ- i JOS ADDRESS AND L TION-•------ `I `' l] -------------- �,. ------------------7 Owner's Name = i }�41i '' ------------------------------------= tea. - Phone " 3`�~ Address --------------------•------------------------ --� _ Contractor's Name. ►,1.�.1. ..0 ''�— -----------------------------------------------------_ Phone_ _._3_ -l S Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mel ❑ Other ❑ 1 'Number of living units: ___ ___ Number of bedrooms __Z Number of baths ----I--- Lot size ...'Y14 l Water Supply: Public system [``Community system ❑ Private ❑ Depth to Water Table 4.4__ ft. ` e Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0/Hardpan ❑ Previous Application Made: Yes ❑ No ®-' New Construction: Yes [R,No ❑ l! .. ,1 . 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 from foundation--------------------Material____________._________________________________- ., No. of compartments-------------------------_Size---- ••-r---------------------Liquid depth---------- -__---------Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------:Distance to nearest lot line______,__________ Number of lines-----------------------------------Length of each line------------------.--------_Width of trench----------------------------------- Type of filter material------_------------------Depfh.of filter terial�_..__.__�..-------Total length------------------------- f______._ Seepage Pit: D•sstance to nearest wel�_T1—--------D• ante from oun tion_ _:__ Distance to nearest lot !i ______.____ . p ----`----- __--Lining aterialM _.. .Size: Diam er___3 -+----------Depth--------------------------------- 4_114 -----__-:-- e ` Number of its..- �-------------------- .�* . Cesspool: Distance from nearest well----------------- istance f oundation___`__._..____.__.Lining material_______________________________________ R ❑ Size: Diameter------------------ -------- -- ---- Dep -'----=--------------------------------- --------Liquid Capacity----------------------------gals. U�r Privy: Distance from nearest well---_--------------- --------.--------------Distance from nearest building----------_.____________________..____--- ❑ r Distance to nearest lot line_____._.______._______.____._ _ Remodeling and/or repairing (describe):--_0" ------------- - -----• � - ---------......--• ` f --..__._______--- \• ----•--- ------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ' ordinances State laws, and rules and regulations of the San Joaquin Local Health District, (signed %) ' [Owner and/or�Contractor) By:................... --- ----• ----------------------------------=-------------------_____------=[Title) _'b ---------- [Plot plan, showing size 1f ot,' location of system in relation to wells, buildings,`etc., can be placed on revers ,side]. FOR DEPARTMENT.USE ONLY APPLICATION ACCEPTED BY ----------------------- --------- --------------------------------------------------------- DATE'fi°----------------:---------------------------•---- REVIEWED BY--•- ''... :�.. ------------------------------------------ ---- DATE •------------- -- +"5-- BUILDING PERMIT ISSUED------------- ---__________..______._______._ DATE Alterations and/or recommendations------------------------------------------ --------------------------------•-------------------•--•-----t ------------------------------------------------ ----------- '" ---". s fir. /..._ .... - S�rtrr '. �tv tae.--. ��:.�u ,...�_.lr .rte..... �.� ---------._! r (a�.r :_----�.a_7�...�- rcJ �rar Ace-AW-2 __. 3�w_sva, FINAL INSPECTION BY:.__ _._-- AL.)------ Date... -P.o.--,!v, --- - -5--�--------------------_ SAN AQUIN 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 145446 ATWOOP