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FOR OFFICE USE""` NO, - ----- ------ ----------�'a °_ ION PERMIT Permit No- ----1 /.-- APPLICATION `FOR SANITAT{-------------------- -----.,� -- (Complete in Duplicate) Date Issued __1�/2_� I-- --------------------- ----------------- This Permit Expires 1 Year From Date Issued -------- ------- -------------- — Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal4 the work herein described. ` This application is made in compliance with County Ordinance No. 49.10 ; I`f JOB ADDRESS AND L CATIO - �T s� ►O --- ------ --- --- Pho .� Owners Name--------------- - -------- - - ------- ------ -- ----------------- - Address--------------- y - v �Cr Phone~ - -------- Q Contractor's Na - - 417 ---_V — f ouse Commercial ❑ Trailer Court El Motel ❑ Other ❑ Installation will serve: Residence L•S Apartment of bedrooms❑ "CN tuber l ------------- ► ' of baths _ ___ t size -- I Number of living units. _/__ N be ( /�ft Water Supply: Publics stem ' Community system ❑ Private ❑ ',Depth to Water Table pP Y Y e Hardpan ❑ I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ;Clay Loam ❑ Clay ❑ Previous Application Made: (if yes,date---------- - ) No 11No El Construction: Yes ❑ No FHA/VA: Yes [ITYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) �l _ p p y Distance from nearest we11______________Distance from foundation ------ Liquid de •th --Mater a__-_-_ -Ca Capacity____-_-- ` Distance ftromrnearest well--- stones from + q foundation____ �' • � Distance to nearest lot` imine_ Len th of each line"___ Width of"trench /- -- Number of lines----- ----- -- gf! p � � �d Type of filter materia- "--Depth of filter' material__._.--.I_ Tatal length_"________________ '�,�--"-------�- y' / --.Distance to nearest lot line ._67- �+ See age Distance to nearest well . Dista rom foundation_________ test lor"_�`------ I Number of pits.--_I-_________________Lining material_____. _ _ Size: Diameter__. � Distance from nearest welly---------------Distance from�oundation-------------" ----.Lining material_------------------------------------- CesspoCapacity `Tl -• P Li uid Ca acit _______--_-gals. Size: DiameterE---- -------- -------- ------- --De th--------- ----- ------------------------------ ❑ q Y - P Distance from nearest building--------------------------i""---- ------ Privy: Distance frominearest well._.._________.__ __ , ❑ Disfiance to nearest lot line------------------------------- ---------- ---"- ------------ ------------- n Remodeling and/or repairing (describe):__.._______ "-""-----------• ----__ -------- ---- ------- ------------------- .-- --- -- -- --------- - ------------------------------------ -------------------------------------------------------- -------- --------- - - --------------------------------------------------------"------------------------------------------------------------- - co San------------------------------ ---------------- -- u I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County . ordinances, State nd rules and regulations of the San Joaquin Local Health District. i --_---_ �Contractar) (Signed) :. --- la -_ r ---- - -- -------------------g--- 1 ---- ----- BY� = Linrelafio ---- (T�t e)- f [Plat plan, showing size of lot, location of systewells, building a#c., can be placed on reverse side). FOR DEPARTMENT USE ONLY �.: DATE / �i ---------------------- DATE----�1 ---�-7- -- ------------------- APPLICATION_ACCEPTED BY----- - _ REVIEWED BY------------------------------" ------- ------------ DA BUILDING PERMIT ISSUED------------- -------------------- ---+J ----------------- Alterations and/or recommendations:---J/-/.ty-A-,9 -�-�_/-- -------------- """""-""•--------- -•------------------------ --- ------------ ------------- ---------------------- ------------------------- ------------- - - ---- ------------------------------------------- ----- -------------------------- ------------ J� Date-- ---- ---f�/, `/�G�'�----- ------ ------------------ FINAL INSPECTION BY:.------ ------ - SAN JOAQUIN LOCAL HEALTH DISTRICT . 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1601 E.Haselton Ave. Tracy,California Stockton,California Lodi,California bAanteca,California