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n 11 rr 1 J � Permit No. _,l- �f �' / p PLfC �l01 �ANITAT(ON PERMIT J G ' I� ltcate Date Issued _--1 -- (Complete in Dup 1 i�. �:- \F ' — - ---- �'"-� _: -- �This.Permit,Ex fres 14Year From Date Issued _ t°: _ -- � ermit to construct and install the herein'�descrbed. ��ss _. 7. - made to the San Joaquin Local"'Health District fora p / licat;on is hereby -th County �k;�nane No. S`}9 �,JJ This application a made in-complia a31 r-`--__-•-- -- SOB ADDRESS AND LOCATION_._.:_:_.-- Q��.. - c.-�-- f� -- �- Owner's Name------- 1�'Imo. !�1 �lr ". .�,3_ 1 �/S-- --- '� -/ :•- phone.-_p- PQ e--- = : Address_.---------•---•--•---- -1 � -----------•------- ---•- -•-...- Motel ❑ O / � _�_�. ---9-��.5'------..__ they ❑ 1J —�� -- � Trailer Court ❑ Contractor's �1 Commercial ❑ F Apartment House ❑ ------------------- Installation --•- Installation will serve: Re��idence [� P Number of baths __ ____Lot size ------- O Number of living units: ---- Number of bedrooms private C Depth to Water Table _ Hardpan ❑ I Community system ❑ Adobe r Water Supply: Public system ❑ Gravel ❑ Sandy Loam N CIaY Loam ❑ Clay ❑ No❑ - ,r-«- FHA/VA: Yes ❑ I Character of soil to a depth of 3 feet: Sand ❑ New Construction: Yes � No ❑ i No Application Made: tlf yes,date_-_-.---- -:---,---:� .❑ f _ .�:.� €:...... previous App it `_1i ti4f I TYPE OF INSTALLATION AND SPeCmFtCT{p blit sewer is available wi#hin 2Q0 feet. _ �QA .�,��7� . - ..:.- v (No septic tank or cesspool p Ca acity--�+ Dis#ante fror>} foundtion----�-U- Maters LI_' -- - Q d ,d 1�, depthh-------- P Se tic Tank: Distance from nearest well___= �- Size._.9- `3 Liquid dep. �------- - Distance to nearest lot l ine--S-------C No..of compartments__ r --------- - T ! Width of trench �.r ---- Length of each line-- ��S(1•--------------------•-- Disposal Field: Distance from nearest well Q-----Distance from foundation ion Total length ____- - i Number of lines---------- ----------- i • _Depth of filter matena_--- � �_ i ;Ty pe of filter mater�al__II I�cS- Di ante from foundation___-_—to---- -Distance to nearest tat d ' 3 t Seepage Pit: Distance to nearest we Size: Diameter__.- !_(aa�r ii � ---------------------------•- 3 Number of pits--------1--- ---- ---Lmmg material___-- -Q-� --- - --- t.`nin material---_-- - i i gals. Distance from nearest well----------- from foundation___--___------ g Cesspool: - ----------------- ------- �� -De th--------- -----------------:�------ ---- --------Liquid Capacity ❑ Sizl: Diameter---------------------- ------------ p ------ Distance from nearest building--- ----------- I --------------- Privy: DiMance from.nearest well---- ----- --------- ---- ------------------- ----------- Privy' --------- -------- --------------- ❑ Di��ante to nearest lot line------------------------ -------- - : } = -------------------------------•----------------- Remodeling and/or r�Mpairing (describe ::------------- a --- ------------ � ��------------------------------------------------------ ---------------------- 8 - --------------------- ----- --- -- ------ '!a ---------------------------------------------------- i . �Ip ----------------------- -------------1 ----- __ha ' 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', and rules and regulations of the San Joaquin Local Health District. W�� // ----_------------_- and/or an / r Contractor) / ------ S�' ' Y By:-------4W:.. _ (plot plan, showing siie o ot, location of system in�a ion o wpe is uil''n s, etc., can be laced on reverse side). II' jh FOR DEPARTMENT USE ONLY II 14DATE------- j~�� ------- - - - ------------------------ --- ------ ---- - APPLICATION ACCEPTED ------------ --------- - - REVIEWEDBY-------- �----------------------------------- ----- ---------------------------------------------------- ------ DATE__ �> - r DATE_ ---------- ---------- ----------- �BUILDING PERMIT ISSUED------------------ --:--- Q--- � . ' ----------- Alterations and/or recommendati s:_____� --- - --- `- -- r - -- ----- ------- -- �/ ^ FINAL INSPEC71,� N BY:----------C-e---�----�-�.t�-D�------------------------ Date_..-------- SAN JOAQUIN LOCAL HEALTH DISTRICT lion Ave. 300 West Oak Street : 124 Sycamore Street 205 West 91h Street 1601 E.Haz II' Lodi,California Manteca,California Tracy,California Stockton,California ES 9 REvIBED B-59II,M 3-'63 F'.P.CO. - � +`