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PERMIT (Complete Permit No. N FOR SANITATION PER APPLICATION � — I (Complete in Duplicate) Date Issued ---- ��1S9 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Appy Y This application is made in compliance with County Ordinance No. 549. JOB ADDRESS 'AND L ION-- ------------ - -- ---------- ------ - Phone Owner's Name---------- - -------------------r�------- -�-------- ---- --- ------- - ---•------ Address----------------------- - ,- -------- Phone- Contractor's Name----____��-��----- -- r Installation will serve: Residence Apartment House [3Commercial ❑ Trailer Court [I Motel El Other ❑ X ----------------------------- _ Number of baths _/__-- Lot size _-_,�-- -_------- Number of living units: �-_ Number of bedrooms ___Z u . Water Supply: Public system El system ❑ Private ❑ Depth to Water Table Z/ ft. Character of soil to a depth of 3 feet: Sand [,],—Gravel ❑ Sandy Lo;��, o y Loam ❑ Clay ❑ Adobe Hardpan ❑ Made: Yes No New Construction: Yes PHA/VA: Yes ❑ No ®� Previous Application Mad. ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) / a Septic T Distance from nearest wel 'e'7 nce from foundation__{f P____-____.Material_---- �'___ !:/G- _-_ Sized--� � K`+�� - Liquid depths Capacity No. of compartments__--_ -- ---- - / - ry Disposal F• d: Distance from nearest well—stance from foundatio�Q----------Distance to nearest lot line_________________ Number of lines=------- --- --------------------Length of each line_- ---- ---��!--1---------Width of trench-,,------------------------- .. Type of filter material___-Yo-c-j!_______Depth of filter material____) _____-_____-Total length--------- -------------------------01 I Seepage Pi Distance to nearest well':_%fn� istance from foundation____- ---------Distance to nearest lot line--- of pits-------- ------------Lining material----�c1C-_-----Size: Diameter__,33------ ------.Depth.-rs�5---------------- ", Cesspool: Distance from nearest weil-----------------Distance from foundation-__-____--__-_-___.fining material__._-_____--_______-_____-____ -s \ Depth-------------------- -------------------------- ---Liquid Capacity_ ----------------- gals. ❑ Size: Diameter--------------------------------------- i Privy: Distance from nearest well------------------------------- Distance from nearest building---__--_---------------------------- -- Distance to nearest lot line--------------------- -------------------------------------------------- --------- ---- ------- -------- ----------- Rem Ing and/ r re airing ( scribe}:- ------------------------------------- i _ ' �4�! ---------------- �- ----------------------------------------------------- - - 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,tandrules and gulations of the San Joaquin Local Health District. x Owner and/or Contractor) �"� l [(Signed). -------------- By:--------------- ---- --- -- ---- ----------- -- -- ------(Title)--[Plot plan, aha sizet, location of system in relation to s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE----- ACCEPTED BY--------- --- ----- ---- ------- � � -- J-�/-------------------------- -- ----- ------------------------------------------------ ----------- DATE------- ------ - ----------------------- ----------------- DATE ---------------- REVIEWEDBY DATE------------------------------------------------------------ BUILDING --------------- - ------------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------------- ------------------ -- ------------------------------------- - Alterations and/or recommendations:____________.____._----_-._-- ------------------------ -------------•-•---•--- -------------- - 1=1NAL INSPE� .. -=--- - -- ---- -- ----- -- Date- nlO ` -SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Strom+ 814 North "C" Street 130 South American Street Tracy, California Stockton, California Lodi, California Manteca, California Y _' ES-9-2M Revisea 1.57 F.P.CO. �.