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' `Perm APPLICATION For �'ANITATION PERMIT _ 1 (Complete in Duplicate) Date Issued d install the work,herein described. lication is hereby made to the San Joaquin Local Health District for a permit to construct an This application is made in compliance with County Ordinan No. 549. fi I ------------------- -------------------1_11-------------------------- ---------------- JOB ADDRESS AND CAT�ION------��----� Phare-=� - --- ----------------- Owner's Name � -------- -------------_---------------- ------ ------ - ' ______ ______ _Address-------- Phone ---------------- Contractor's Name------------------ Motel Other ❑� .Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Lot size ___ Number of living units_-"Number of bedrooms _____ Number of baths -- Water Supply: Public system Community system ❑ Private epth to Water Tabl4o_ ft. pp y: y ❑ Cla Loam ❑ Clay ❑ Adobe J Hardpan [] Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sanndy Loam ❑ Y T x Previous Application Made: 4Yes �No [I - -New Construction: Yex No ❑ TYPE OF INSTALLATION A D SP CIFICATIONS: (No septic tank or cesspool permitted if public sewer is availab a within 200 feet.] Distance from foundation_��-------'MaterFia�__ ____./ - - d } Septic Tank: Distancelfrom nearest well-_ �/----- i uid de #h__ -7 p y " q t lot line-----�------�. No. of compartments_ Size__ ___- " aresaut ' � / �� pistance #o rre ---------- Disposal Field: Distance;from nearest weli__��----Dis#ante from foundation^_�-} Width of trench___.�-----------1----------- , Number"of lines__________ _"_ _ Length of each line_ C �� ,� -Total len th ��-� Type of filter material ____Depth of filter material----- g F Distance to nearest lot line. ---- 1 " Seepa a Pit: Distance. to nearest well_/ -Distance f m four�dation___ _ _--•- , /- Depth,, _� ------------ VNumber;of pits------- ------Lining material * Size: iometer_ --------- W � Distance from nearest well__-___-"____-_-_-Distance from foundation________ Lino d Ca Capacity gals. ► Cesspool: P Y•-------•----------------•-- ❑ Size: Diameter--------------------------------------Depth_-.-y--------------------------------- q "'!'" Distance from nearest building----------------------------- Privy: r Distance from nearest well--------------------------- -- ❑ Disfiance,ta nearest,lot ire__"------------------------ ----------- --------------------- s - --� Remodeling and/or repairing (describe):--- "-- ---P•-4 -------------------------------------------•--- -- ------------------------------------ — — '---------------------------------�-— — ---------------- -------- ------ - ------- ------------------ -------------------- --------- --- --------------------•----- €I I I hereby certify that l;have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5} #e'laws, an �le and regulations of the San Joaquin Local Health District. f ��_ ..._ _ -- ------------------------------------- (Sign --------------------------------- ______(Owner and/or Contractor) i 5i red ( g )--- - fe C �- {Plot plan, showing siz af'lot, location of system in relation to yells, buildings, etc., can be placed on reverse si e. � FOR DEPARTMENT USE ONLY a � � r DATE------------ ---- ---- APPLICATION ACCEPTED BY �.�`-- � REVII=WED BY------------------- ----- ------ ---- - ----- - ----' ------ '----' --------- -'----- ------- --------------- -- DATE ---'--- --------------"---------------------------- - DATE------------------------------------------------------------- p BUILDING PERMIT ISSUED----------------------------------------------------------------------------------,----------- ----------- io -------- --------' Alterations and/or recomendt - -_ ` ---- , - � � --- --- es =__ =` -_- I - --- - -- _ FINAL INSPECTION BY:-------------=-- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C Street 134 South American Street 300 West Oak Street Lodi, California Manteca, California Tracy, California Stockton, California. � ES-9-2M 8-51 Revised W-2100