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FI-. = , ION PERMIT P rmit No. ...�...... FOR OFFIC):}JSE R SANITATION r��..��/ �' 6 Date Issued Z (N FO 't tz rkj licate) U .-__------- Complete in Dup APPLICATION This Permit Ex ires 1 Year From Date Issued ---------------�l�,'} t permit to construct and install the work herein descr�e ---------- uin Local Health District ora p made to the San withJoaOrdinance No. 549. Application is hereby Bance with County �j �� _ � 0 This application is made in comp '70esS _-..-. ''`"'` __._.•.............. Ifs------6— - .---- _ JOB ADDRESS AND LOCATION A �----------------- - ----- Owner's Name -----------•----------------- --••-- _. Phone........ •- I Other Address-------------- Motel -- - Trailer Court ❑Contractor's Name----------------------• Commercial ❑ _ .®.......�--...._��..0�....... -•-------- Residence ® Apartment House ❑ Lot size .•... Installation will serve: Number of baths _--•- _ Private Depth;to Wat�"Table Hardpan❑ Number of living units'. _...�--- Number it bedrooms❑ p m Clay ❑ Adobe% Public'system ❑ Community Y Clay Loa ❑ A;Yes ❑ No 9( Water Supply: Gravel❑ Sandy Loam❑ ❑ No � FHA/V depth of 3 feet: Sand ❑ ) No New Construction: Yes Character p soil i o a dep I f es,date---------- - Previous Application Made: l Y public sewer.is available within 200 feet.). . TYPE OF INSTALU k o ce pDoSPECIFICATIONS* t iMaterial-.------- -- ------ (No septic tan -------------------- th-------------- ----------Capacity ---••- . Liquid depth - Distance from nearest well_________________Distance from foundation..._----------- - $®ptic Tank: artments-•------------------------Size-------------------- t line No. of comp Width of trench------------•-:-•---------- . well-----------------Distance from foundation._......._..........Distance to nearest o Field- Distance from nearest Length of each line----------------------- th------------- pispos Number of lines------------------- th of filter material-----------------------Tota eng pep .._ / �........Distance to nearest lot line-_----------•'--' G Type of filter material._______ - - pistance from foundation.....- . .Depth _.- ---- --•-____.Size: Diameter_ Distance to nearest well _- material__ Lining Seepage,Pit: Pits--------------------------------------- materia----------------------- ------...-- --gals. Number of p Liquid Capauty ..- -- ----- •-------- Distance from nearest well-----------------Distance from foundation__- -- Cesspool: Depth----------- -------- ❑ Size: Diameter____. --- •------ --- _ _--_Distance from nearest buil ing -:- -••• Privy: Distance from nearest well-------------------------•----••- - _.---•--•-----•----- •....... ............. Distance to nearest lot line------------------------'------------------•---- ................................... ..---•--- - Remodeling and/or repairing --------------------------- ill and that the work will be done in accordance with San oaquin County ----- this application Joaquin Local Health Distric . I herebycertify that I have prepared Mations of the San Joaq _(Owner and/or Contractor) Sta?1ad rules and reg „_._. ordinances, ------------------ ----------------- (Title) (Signed) �j ' s etc., can be placed on reverse side)• __• stem in relation to wells, building , By:- (Plot plan, sho lot, location of sy FOR DEPARTMENT USE ONLY &/ ------- ---------------------------------------- DATE-----_.��/3-- - -------- - --- -.. ------ DATE.-•----------------- -- APPLICATION ACCEPTED BY ... DATE---------------------------------- -----------------------•- -------------- REVIEWEDBY----------------------- ------------------- – --••-- ------------............. BUILDING PERMIT ISSUED..----- - Alterations and/ or recommendations:.------ "`�.. /----- ----------......... ............. --�. ---- 6 - -, ---------------------- - ---- ....... . . ......f__.. --- ..._____...__._.__._. ---------------- ----- Date---------------- -------------- FINAL - -FINAL INSPECTION BY - UIN LOCAL HEALTH DISTRICT SAN JOAQ 205 West 9th street 124 SYcarnore Street TracY,California > 300 West Oak street Manteca,California 130 South American street Lodi,California Stockton,Californio E9.9 REv16ED 8-59 F.P.CD-aM i.io