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APPLICATION F.ORNANITATION PERMIT a (Complete in Duplicate) ��erm+t �Ialo. - + � Date issued �-•�_�__ � +�Application is hereby made to the San Joaquin Local Health District for a ermi T is.application is made in compliance with County Ordinance Flo. 549. p t to construct and install the work herein described. JOB ADDRESS �A D L CA 1 Gj.-Q---- ---- 1 Owner's Name.-- ---�-�-�' •--•-••-------•--------- .�• .; ---- -- - ---- - -------------------- - --'-----•-----•- -••..r_._.,�..,..�_-�.�..�_--_-,-M Phone_4_____ -•- on rac+or's Name------ ----_ ---•--•----------- ------ Installation will serve: eside ------------------------------------------------------ -- 1 ----------•------------------------------ ncePhone----•-------------------'---- ----- ,. Apartment House E] Comm ❑ercial.> Trailer Court t Number of livin units: - -_ ` 4 ❑ Motel Of e� [] umber of bedrooms"_-_-; Number of baths . - Lot size _---I ! y Water Supply: Publics stem N'-"` "''�' Y Communit system -�- Y Y ❑ Priva to ❑ Depth to Water Table -----_-- ft. ------ Character of sol! to a yepth of 3 feet: Sand Gravel ❑ Sandy Loam -' ' Construction: Yes [�No ❑❑' Clay Loam E3Previous Application Made: Yes Clay ❑ Jdobe fe''Hardpan ❑ TYPE OF INSTALLAT& AND SPECIFICATIONS: (No septic tank cesspool permitted 'f ublic s wer is available within feet.)r Septic ank: �`�""�� • � _ ply Distance from nearest well-- .__-_--- _-Disfian fro foun�ction_-,�-� _ — ,_ No. of com artments-_------- -- aterial_---_--_- p rz -•--•Liquid �. Disposal Field: Distance from nearest well�_�-- --__- q �ep�th_-:- -_--. _.-__-_Ca acit /_ � p Yr-�=�r/ -------- ...Distance fro undation D' ="=--.13rstance to nearest loft li v . 9 Number of lines------- - -_-- ---_-_- � �nath�of�ech line---- - I Type of fitter materi I- - 3 © ---- -•-----Width of trench.._.--- -------- Seepage ----_ epth of filter ateriai_--_.-/ pit: ----------Total length--_--__--- Distance to nearest well --------- - ...... from foundation------------- -- Distance to nearest loft line._--------_--- - ❑ Number of pits . . aLmang�cmaterral.--,_ Size: Diameter---_----- -- Cesspool: Distance from narest well De th-- -_ -.--- _------ r�D.isfancfrom foundation-_ --_--' gyp j ❑ Sire: Diameter---i----_--- - -- Lining maferial------------- -.Depfih=----------------------------- } - ------1 Privy: Disfance from nbarest well---------------- moi, a r f - - .�squid Capacity..------------------- gals•••••k ---------------- -------------Distance from nearest building X"� F ❑ Distance to nearest lot line_--_--__-_-_---_ g ---------------- Remocleling and/or repairing (describe)--------------- --- w' ------------------------'------------------ ---------------•-----_--_-_-_---..----__-- ------------- ---------- --•_;1hat-----.----- --- ----------------•-•--------•------------------------------------------•--• --------------- ---------•---------•-----•-------------•------------------------------- I hereby certify +hat I have pre ared this application and that the work will be d�O ordinances, StatPaws, and rules an regulations of the San Joaquin Local Health Dil+ric+. Ane in accordance with San Joaquin County (Signed)-------V�'--•-�.,,�"ts ' --------•------------------- J By: � ,,, .(Owner and/or Contractor) (Plot plan, showing size of to+, locati n of system in relation to wells, buildings, etc., n be placed on reverse ` � - rtle) 17 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8 - REVIEWED BY------------------- DAT ---------------------------- BUILDING PERMIT ISSUED -•---- --- -- ------------------------------------------ --------- DATE-- DATE--- ', Alterations and/or recommendations----------------- - --------------------------------------------•----•--------- FINAL --------FINAL INSPECTION BY:._-_--..- � ---------------- -- --------- Date. ------ --- --- SAN JOAQUIN LOCAL HEALTH DISTRICT ------------------------------ r 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore Street 814 North "C" Street ES-9-1M 10-52 Revised W-1100 Lodi, CaliForrtie Manteca, California Tracy, California