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, OTION PERMIT Permit No,� U-;......-- �' APPLICATION FOR SANT [Complete in Duplicate) f ------ it - Data Issued __ �,rr- --- Application is hereby made to the San Joaquin Local Health Distri or a per it to construct and install the work herein described. } r This application is made in compliance with County Ordinance N 49. ' JOB ADDRESS AND ATION_ -- ------- JOB - � I Phone_ F Owner's Name--- :. Address-- - ----- --- ------ ------------------------------------------•---------------------•-- h - - --- --- -- -------- Phone - �.� Contractors Name_________.."-- ------- ---- ------ --,-------------------------------------- I ------ - --- -- Motel Other Installation will serve: Residence Apartment e ❑ Commercial ❑ Trailer Court ❑ ❑ �_-- Number.of baths _ -- Lot size .- 0 y��--------------------------- 4 Number of living units: /__-,.Number of bedrooms l "" "� Water Supply: Public system ,Community system [IPrivate [I Depth to Water Table �13_ ft. 5 .W ' Ado Hardpan Hard an Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam E] Clay Loam [I Clay E] P E] Previous Application Made: Yes ❑ No New Construction: Yes ' No ❑ l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance n cor arnearest well----------------- from foundation-----------_--------Materia4---------------------------------------------------- No. _____--.:_______-- --------=---------- . Se tic Ta Distance from''tments_"""-- ----------Size---•---------------------- ---- depth--------------------------Capacity------- --------------- 4 P Distance from foundation_________________--Distance to nearest lot line___..______-.-_-. ,., ' p , �{�1 -------- Disposal F' d: Distance from nearest well------ 'Length of each line_-_______--_ __.Width of trench___________________________________ n� Number of lines--------------------- -------- " "'Depth of filter material-----------------------Total length--=-------------.--------------------...� Type or filter material---------------""""-- - r Seepa e Pit: Distance to nearest well_, ------Distance Xn fo dation____-,_,tr__._______-Distance to nearest lot line---L--------- Number of pits_^.--------------Lining materia]'(-----.Size: Diameter_---J�-�------ ----Depth- U------------------- R -` -------------- Cesspool: Distance frominearest.weil_________________Distance from foundation___----__________Lining material- ______.___________ als ❑ Diameters -De Depth �. ---------------- Privy: --- Liquid Capacity gals,p . -= Privy: Distance from-Inearest ti�ell-------------------------------------------------Distance.from nearest building----------------------------------------- ❑ r '-------- -------- - Distance to nearest lot line---_"_____ ° F - ---•--- rin (describei:_ Remodeling and/ g ; ------------------------------------------ :- - --------11------ - ------------------------ ------------------------- _ __ ---------- ___ „. ---- �- •- ------ ----• __.. V ---- -- - -------- ----------- Q ! her y certify tha ! h prepare is application d that the A will be done in accordance with San Joaquin Count ordinane State laws and les" nd lations of the n Joaquin L a{ Health District. -•----r- .--- ----- -- _____(Owner and/or tractus] (Signed) Con - ---------------------------------------------------------------------------(Titles------- ---------- [Plot plan, showing size of Ie' iloz Pion of system in relation to wells, buildings, etc., can be ced on reverse sid FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - DATE---------._"-- —�� - --- - --------- y - ------------------- DATE----- •------ ------ - I REVIEWED BY--------"-------------•----------- ----------�-------------------------------------- --�----------- -----�- - ---------- - --- DATE. BUILDING PERMIT ISSUED--------::. = Alterations and/or recommendations---------------- --------- -----•-------------------------•-----------•-----------------------------...- ___________"___________"..___.______ ,E ________----------------------------------------------------------------- Si _____________________________""-..__... l ------------- - ---- ------------- . _______________________________________________________ ---------------- FINAL INSPECTION BY: r tuX� ---- ------ Date -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 11132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Y Tree California Stockton, California Lodi, California Manteca, California Y ES-9-2M 10-52 Revised W-2100 W. r