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_.� TATIOPermit Na: _ " (� APPLICATION FOR SANIN PERMIT (Complete in Duplicate) Date Issued ._.__-,---------------- rw +' n is hereb ' made #o the San Joaquin Local Health District f 9r a permit to construct and install the work herein described. Applica �o Y This application is made in compliance with County Ordinance No. 54 � y------Z-- �. = -------- ---------------------------- ------------------ ON---ADDRESS AND LOCATION----------- --------I----- phone---Il - --------- t �------- ------------ -- ------- ------------- _ -- .----------- Owner's -- Owner s Name -:; - .' --- ----------------_- --------------------------•----- -------------------•�----------------------------•--- Address------------------------ - = one ----------••----•---- --------- ------ ------ Contractor's Name------------------------------------ Commercial ❑ Trailer Court C] Motel [I Other [IInstallation will serve: Residence Apartment House [II g -�` number of baths ----- Lot size .--------- � a ------------------------- Number --- -------Number of livin units: ___-_- Number of bedrooms _ _ N _ Wate.1 is= Supply: Public system.y Community system ❑ i Private ❑ Depth to Water Table .___.--- f+: Gravel Sand Laam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: , Sand ❑ ❑ Y ` Previous Application Made: Yes ❑ No New Construction: Yes No 171 3 TYPE,OF .INSTALLATION ANP SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 5e tic Tank: Distance from nearest well_________________Distance from foundation--------------------MateriaL______------------------------------.,--------- p Liquid de th---------- -----------Capacity-•--------------------- ❑ No. of compartments---- ------ •------- ----$ize-------•nce-------•- ------ ----- q p• ncl Distance Disposal Field: Distance from nearest well------------- Dista Length of reach 1 ne.ation Width oftfrench est lot line__----___---.-- , . Number of lines---=-------------------------------- ❑r Type of.filter mater ----------------- e- filter material----------------------Total length--------------------------------- I - ... :...._. i. r .. .. •+T Seepage Pit: Distance to neaiest(well--_----Linin --Dis aanc a from founds Ze n Diameter.- Distance to nearest of line ___--------- Number of pits----__.- 9 ► Cesspool: Distance from nearest well-----___-___-_._-Distance from foundation._- materia- --- als. Dept Liquid Capacity------- ----- - 9 --------------------- --- ❑ Size: Diameter--- -- - ------ ------- ------ - -.� - ------ `��-- ---------------- ---- _____-__._Dis#ante from nearest building-- Priv :{ Distance from nearest well —1— ------------------------------ fi- = 'Distance to nearest lot Ione-------------==---------------- - - r -----------•-------••------------------------ ----: ... -•-----•--------- Remodeling and/or repairing [describe------------------- 6 ---I-------- --------- ------------- ---------------------- ------------------------------ l --------`------•-•------•----------I----------- _______ -------- _ �P�. I hereby certify-that I have prepared this'application and that the work wili'be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Owner and/or Contractor) ntra or 5i ned 1= -41 , ---- --------- ------- ( 9 } I . - ° -----------(Titl --------------------------------------------•----------------- e}- (Plot plan. showing-siie of lot; location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE '~ APPLICATION ACCEPTED BY--------- --�------------------- - ----------------- -� - - - DATE--------------•-•---------- REVIEWED BY----------------------------------- ------------------------------------ •------------ ---- -- --- •- ------------------- - ----- --------- DATE--- --------------------------------------------- ------ --------•-------------------- BUILDING PERMIT ISSUED------------------ -------- - ---I ••---- -- Alterafions and/or recommendations:--= ---':=_.- --- ----------------P ---•--- --------------- --------•--- ----------------------• t ------- ----- :. -----------------•---- ----------------------------------- ---- ---------------- --------------------- Date --- ------------ �1�' --------------------- ---- 1=lNAL INSPECTION BY--------- ------ ----� ------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C' Street 130 South American Street Tragi California Stockton, California Lodi, California Manteca, California y' me 0. -o AA : ' Rrvixed W-2100