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`=S'-�—'-�'— ------- -.. .ice, :� -- -- ' 7 yr!/--f j. (Complete in'!Duplicate) „ .,Date Issued _ -__..._ This Permit Expires 1 Year From Date Issued -------- - t Application is hereby made to the San Joaquin Local Health Dist ct,for a permit to construct and install the work herein described. This application is made in compliance withi�County Ordinance N4� 549. # -f ------------------------------------ -------------------- 71 ' F �` D LO ATION--- _J(1 - �l' � JOB ADDRESS AN ------------- Pone t ----._ Owner's Narr+sh. = r _ -- -- y��xx f/ -- •-- ------------ - `------------------------------ ------------- �...__ -x---•--7 -f-•4--- Addressone •----------------------------- Ph Contractor's Name_______________ __ _----------- I Motel ❑ Other ❑ Commercial Trailer Court ❑ Installation will serve: Residence Apartment House ❑ ❑ i M ----- _. --------=----------- mbee of bedrooms _- Number of baths - -- Lot size _ j Number of living units: ] Water Supply: Public system Community system ❑units- Private ❑ Dep} }o Water Table -- ft•"�' t r # Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] :,Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ �!: FHA/VA: Yes ❑ No C '' Previous Application Made: llf..yes,date--r ------------- -I 'N9.L� New Construction: Yes �o ❑ .47 TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available with"n 2200 feet.) lam(____Distance from foYnd.a}ion__, 6____..__.Materiel f = Septic T Distance from nearest �' p Size_ Li uid de h----4 CaPacitY ��1 �1 "tK� Gan - G P 1 No. of compartments_.:__..---_-�- - �i f �' - -- --- Disposal ield: Distance from nearest,w Il../� Distance from foundation v f_e _Width oftofrenchnearest lore----- ._---_-- Len Length of each,line- --__.-- -- Number of lines------------------ ---- - 9 rs1. Type of filter materiall bi- -a�Dep6 6 filter material-_-- - ------'---- 9 4. 1p .11 Seeit: Distance of to nts rest "III -Dista nee fr m kT ndatiorn---- Q_.______Distance tonearest line-�...:......... Seepac f Size: Diameter.--- .------ ----Dept pits 16 material _ -'-- y. Cesspool: Distance from neares� well________________Distance from foundation____.__.---- -----.Lining material:.-__..P....__'______.____.__-----•- 'i ❑ Size: Diameter-----------} -------- -------- -----Depth =' -__.---Li Liquid Capacity.- gals. �� _---Distance from nearest building-.._-_----------------------- p Privy: ----------------- ' Distance from nearest well-------------------' -- --. --- ----- ❑ Distance to nearest lot line..---'---------------- _ ------- 4-A I-0 --- - --- ----- . ------ --------- ------- I' Remodeling and�or re airing (describe):_:_ - '---' - - _------__---- --- ------------------------------------------------------------ -- ----- ------. '------- --- '---- '- `-----=--------------------- f �� --------I!;------------------------------------ --------- ----------------- ----------------- I hereby certify that I have prepared this application and jAt t the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. l actor] ..(Ownerand/or Contr (Signed)_ ---- -- ------------------ ---- ` - ----------------:- - ----- ---- ----- (Title)... By:-------------------- inI - - --- ---- - buildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, location olf system relation to ells, f FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED BY. _ ._�� r � = ------------------ DATE-----lz�A�a----------- ----- -------'- � DATE------'------------------------- --------------------:- REVIEWED -REVIEWED BY-------------------------------- � . A ------------------------------------------- BUILDING '------'---- ---'---------'- -------'--- BUILDING PERMIT ISSUED-------------------) -------------------------- :-----------.-------•---------------- i �.r ' mendations- ----- ---------- --- ' -- ----------------------------------- Alterations and/or recom -' ---------y . .. ... ------' F s, S-3'— D 67 � to-- ------ ' ---- -- - ' FINAL INSPECTIO BY:...__. -. ;- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West oak Street i 124 sycamore Street 205 West 9th Street 1401 E.Hpxelton Ave. 'Lodi,California � Manteca,California � Tracy,California Stockton,California I: ; ., T,