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FOR OFFICE USE: Permit No. - � . J�;a o APPLICATION FOA 5A1lSATION PERM IT 6 (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application 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. 1 JOB ADDRESS A LOCA ION __14--- ` Phone--------------------•------- - Owners Name------- ----------------------- -------- ---------. -------------------------------- -----------•------------•------ Address----------------- - ----- one --.------------------•------------ Other ❑ --------------------- ---------------------------------- P Contractor's Name_______ ,f Trailer Court ❑ Motel ❑ O Installa+ion will serve: Res'sdence Apartment House ❑ Commercial ❑ . if$umber of baths 9-- Lot size -� Number of living units: -/--- Number of bedrooms }h to Water Table eft. Community"''system ❑ Private @eep Hardpan ❑ Water Supply: Public system ❑ - --Cla Loam~❑—�elay-DAdobe I --Gravel- -� Sandy-i=oam-Q Y• �/ Character of soil to a depth of 3 feet: Sand [] ❑w". FHA/VA Yes � No ❑ New Construction: Yes �o ❑ Previous Application Made: (If yes,date-_.-__- -- } No [ t TYPE OF INSTALLATION AND SPECIFiCATIIONS: ]# (No septic tank or cesspool permitted if-public sewer is availablewithin 200 feet.) w <-�---- - j Distance er a1_441 from foundation_-" - ---- Septic Ta k: Distance from nearest w t Ca acit Size-_sal-"- X.�---=---Liquid depths P Y , No. of compartments_-- Yf �_ �_"_� i�- ^�p�; Distance to nearest lot'line-4-------- k Disposal F e}d: Distance from nearest well_- - .._-."-Distance from—foul at i Width of trencli._- .---_- `` en th of each line.-- l+s _ Number of lines---------------- - g / /� � Total len th=..� -- ------------------- p --------- ----�;-.: - Type of filter material _Depth of filter material-- g pistance fr m fo da#ionjjO� T---Distance #o nearest I t line_- ----,---- J. a Seepage P•t: Distance to nearest welt-_ -- ,, _ Size; Diameter._ c - ----Depth_ ----!' �f Number of pits_-_- -----"------Lining material_- � - Distance from nearest wellDistance from foundation-------.- ----.Lining material._ Cesspool: i _ Liquid Capacity--------______"____...__._gals. ---De th---------------"------------------------------ q ❑ Size: Diameter_--------------- •- p i Distance from nearest well------------------- Distance from nearest building..-- ------------------------------- - 1 I Privy: ----'-----= - -------- Distance to nearest lot lin e__-"----- - � �. f/ t ' "__ ----------------------- ----------------------'. i --- � ------- ---- Remodeling and/or repainng describe):____-_-` .._ - ----- 1 hereby certify that I have prepared this--application-and-that-the-work-will-be-done cin accordance with San Joaquin County ordinances, State laws, and rules and regulations the San Joaquin Local Health District. ✓ ----- and/or Contrac# [Owner a d/o --- ----------- ---- ---------- (Signed) ------- i ° [T'#I 4 --------------- - - ---------------------- --------- e) BY -------------------------------- --- '7" (Plo+ plan, showing size of lot, location of system in relati f o wells, buildings, etc., can be place on reverse si e. fi r FOR DEPARTMENT USE ONLY DATE--------�W . ---------- ------------------------- APPLICATION ACCEPTED BY---------- t ----- -------- ---- ---------•-- -- -------- DATE-- --------------------------------------- --------• ----�-� DING PERMIT ISSUED--------------------------------------- ----------------------•----- ----------------- = ----- �------ DATE------------------- ------------------- -------------- BUIL Al+ ati ns and/or recommendatio s---------- -- -- [�� p b r --------------------------------------------- -------------•-------------------------------------------------- -------------------- -mer r - -- ------- ----------------------- ------•--------------------------- --------- - -------------------------- FINAL INSPECTION BY--------- --- ---=- -�- - ------- ------ ----------- Date------- SAN"JOAQUIN LOCAL HEALTH DISTRICT r C 124 Sycamore 5 reet 205 West 9th Street 1401 E.Ha:elton Ave. 300 West Oak,Streety` t � a , I Stockton,California Lodi,California Manteca,California s Tracy,California F.P.c 6.