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, , Permit No. ..-1--��- PERMIT NJ" APPLICATION FOR SANITATION �i1h 5 h✓ v (Complete in Duplicate) Date Issued ------- ��Appatbn is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. (, .fitY�-- -t JOB ADDRESS AND L CATION----- - ----- =----------- / � - -- Phone _ ---�- C f L [. _I_!::._[.�--'—~---- -- -------------------- -- - ---- Owner s Name ------- -,� � � --•-----••-- r. Address -------- C p =-------------- Contractor's ----------- fi r -C-1------ Installation --------------- ------------ Phone-_.*---- 4) -C--{Contractor s Name-_--_-�•�/--.-i•-�=� Motel Other ❑ will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ el ❑ Number of livingunits: _ - Number of bedrooms ---`_ Number of baths -__ Lot size ...... f+ Water Supply: Public system [ Community system ❑ Private ❑ Depth to Water Table Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe 'ai-Hardpan E]Character of soil to a depth of 3 feet: Sand ❑ ❑ yNo ; Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ ❑ "W'` TYPE OF INSTALLATION AND SPECIFICATIONS: 41 'ANo septic tank or cesspool permitted if public sewer is available within 200 feet. Ta Distance from nearest well__-.._-.__--.--Distance from foundation_-----------------Material_-.___..___...-.-.----..---------- f , ------Li Liquid de #h- --------- --------------Capacity--•--------------- r- �i, No. of compartments-- - Size-------------------- q p. Disp al Fuld: Distance from neares well_ 0.__..-_`Distance from foundation__.. __-- Distance to nearest lot line--3-_-. Len th of each Ilne_ � Width of trench-" - ------------- �;.�` Number of lines 9 �/ / jj Total length 6 ,} Type of filter material_ �1� -- Depth of filter matera!_..._j�j_ .f W Distance to nearest well_.�a+�=.---Distance ,£tom foundation--------- Distance to nearest lot ine_____..._________ eeaipJ (N Limn material-_ Size: Diameter-._,.f.- ---------Deptn-- 7_ S--------------------- g Number of pits-----1- . Cesspool: Distance from nearest well.-.- .-_Distance from foundation_ -._._- Lining materia!___... ----------------- Cesspool: O ❑ Size: Diameter--- - --------------- - ---- -Depth---------------- -------- - ---- ------ ---- Liquid Capacity------ 9 Privy: Distance from nearest well------.-_----------------- ------- --- ----- -Distance from nearest building----------.------------------------------ ❑ Distance to nearest lot kine------------------- - ------- ------ - --- - RemodeVing and/or repairing (describe)--------------------------------------------------------------------------------------------------------------- -------------- ------------------ -------------------------•,> )and --------------------------------------- ----------------------------------------------- I hereby c'rtify that haed this application and that the work will be done in accordance with San Joaquin County ordinances, S} a laws, d ruegulations of the San Jo n Local Healt, •District. ! ; t r Contractor) --- -- ' _ (Signed)_ �-�k ------- �., f ( e) -- ---------- - By:------ --------------------- - (Plot plan, showing size of lot, location of system in rela}ion to w` 115, buildings, et , can be placed on reverse side. FOR DEPART TENT USE ONLY APPLICATION ACCEPTED BY----------------------------- ---------- -------------- -------------------- ------ DATE------------_----------- ------------------------------- DATE-----_..e--------------------------------------------------- BUILD NG PERMIT ISSUED--------- - ------- ----------- ----------- - DATE----- -`--------------------------------- ----------------- Alterations and/or recommendations:---__-..__- -- ------- ----- - ----------------------------------------- i--..-- - ---------------------------------------------------- / ----- .____ -------------------- ----- -- ------------------- ----- - --- ---------------------------------------------- --- -- ------ --- --- ------ -_ ---s.� r r f 6 4 S � :- r � � Date- - - -- ------ - - - --- ----- ------------ ------------------ FINAL IN SPECTION 13Y:__. _--- � SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y ES-9-21A RevPsea 1.57 F P-CO. •