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APALICATIQIV fip°R S,4NlTgfilON PERMIT [Complete in Duplicate} Permit No. Application is hereby made to the San Joaquin Local Health This application is made in Date Issued compliance S with Count District fora ` •- y Ordinance Permit to construct and instal(the work herei J08 ADDRESS AND � No. 549. LOCATIONn described, Owner's Name - . AddressIr _----•--------•---- - •-- ----------------` _l._ Contractor's Na _.. Phon �� .--p-.7 3 I Installation will serve: ---- partment House - - - Number of living units: -P CommerciaWater Su ber of bedrooms _ ❑ ' Trailer Court ❑ Motel ." PPIY� Public system ,� Community � Number of baths __2! ❑ Other ❑ � �-om�munity system -- Lot size •-_ 'r - Characfer of soil to a depth'of 3 feet: $ ❑ Private 4- '? _ -1_- I ❑ Dep}h to.Water Table ft. ---•- f' Previous Application i and ❑ Gravel ❑ Sandy 1 Mader- Yes Y Loam,❑_Clay Loam 1 TYPEtOF INSTALLATION 1 ❑ No ❑ ,Y New Construction: Yes ❑ Clay E) Adobe 1 (No septic tank or-cesspD Sper iffed {IO ❑ No �A�VA: Yes ❑ No ardpanr NS: G ;r, ❑ # public sewer is.available within 200 feet.} Distance from'nearest we 1L_ No. of cbm = -Disfance from foundation_"~`"` `—�- csal partme'ts Size • - ------------------------------- 4-1e d: � � -.----------Material --- --C pacify - � � -- -- ------�----------Liquid depfh----- --- - . --------- "�. Distance' from nearest well-_�Qle.t� _ ___Number of lines__ - _Distance-from {oundatio _---_� Q Length of each line... ---`--Distance to nearest lot Type o{ filter material-. -- -. C _ ►Depth of filter,material_-. 'y-----Width oftrench--_-- Seepa p ,ge Pit: a length Distance to nearest well-_Ik..�' --1 -----_ To t l ! ngt ----- Distance rom oundation_( Number of pits --=�- --- ------ ---Linin ' © '---------------�---- Cesspool: $ , 9 material_-_ �=- Di tanc et o nearest lot line_<71", — `-_Size: Diameter---__ ,� Distance from nearest well_--- ___ ❑ Size: (Diameter-_--.--` --Distance from foundation_-------- -Depth-----, �- ------------------ --------T Depth ------- ---.Lining material---------------------------- rivy: �"Distance from nearest well ��------ --- --- --- -- --- ++ ❑ ------Liquid Capacity- _---_------ 1 _ Distance from nearest buildin gals. nearest lot line- - ---.----••-- --------------------------. . 4- �b ' Remodeling and%or repairing d 1` nce o� ----------- }.-- - ------------------------- ------------ ------------- ------ -------- .. .. _ _ --- - 1 hereby certify that ! have prepared this application and +hof +he work will b = ----- --------- ordinances, St •� ��ws, and rules and regulations of th6e San J -- o .-.- --------- [Signed) in accordance with San Joaquin Coun+y ` {Signed-- �- q- w- .. 1 � Local Health District uC1-" � ----- (plot plan, showing � _ - = ontractor) g size of lot, location of system in relati o ells, -- -- {rile}-------'_-- _ 4s, tc., can be placed on reverse side}- -------- ---------------- FOR ARTMENT USE ONLY APPLICATION ACCEPTED BY-_-_.______ REVIEWED BY-------------------- -- -------- - ----------------- --'• ----- - ..- ------- DATE.---- BUILDING PERMIT ISSUED_--------_ - - DATE--_-_-- _ Alterations and or recommendations:_---- - -----------------•__-- DAT I __:__ a`tif �� -------------- ---- :::::::::: E_ �::�::::_�::::�.:-:::::::::::::::: - ------ I- /'_..------__-'"-"-_- 9_.. -----------------•------------- ��> -. _. ----------- `.�QN+ D�9 - e r, ----- _- n r s ----------- ------- -------- - ------ 'FINAL INSPECTION BY:.----__--- -------------------- - r --�� - -----•---------------------- -----` - -----�- Date---- --- x ;' SAN-JOAQUIN LOCAL HEALTH DISTRICT -------- -------------- '130 South American Street, At, , a a Stockton, ' ' 300 West Oak Street California 132 Sycamore Street _ Lodi, California 814 North "C" Street k Manteca, California —2M ' Revises 1.57 F.P.Co. Tracy, California - i