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(Complete FOR ieB SANITATION PERMIT Permit No. _ n Duplicate) 'P ) / Date Issued A Thispplication is hereby made to the San"Joaquin Local Health District for a permit to construct and install the work herein described, application is made in compliance with County Ordinance No. 549. 1 JOB ADDRESS AND L C ION. — V - •- --------- -- Owner's Name.--=- - ---- -- -----¢- - - - - -----•---- -- -------- -- - -• -- -- -------- N=----- ---------------------------------------- Phone... ---- Address-._ - r f 1 ---------- ss... Phone- Contractor's Name--------------- -- - } - - - ---------------------------•------ ' -- Pone. � ...�.� ` Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer. urt Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms --------71 Number of baths of sizef '4! f Water Supply: Public system ❑ Communify syste—]PrivateQepth to Water Table s zl f}l - .. .w Character of soil to a depth of 3 fe'e,: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay. Adob Hardpan ❑ Previous Application Made: Yes ❑ No �ew Construction: Yes a E r No ❑ FHA%VA: Yes ❑ No E]. I' TYPE OF INSTALLATION AND SPECIFICATIONS: = (No septic tank or'cesspoo! perLmitfed if public sewer,is available within 200 feet.)--t a i Septic Talk: Distance from nearest well. d___-___Qisfance from foundafion.-._;71.,A,0_ e ; �/ , . No, of Compartments.-__, _.5ize_ i ` ------------ -- -- !�- Liquid depth Ca acct Disposal .ielcl: Distance from nearest well_-9.0-_r-1 Distance from foundation_.-QI_Or_-----.Distance to nearest lot line_.1�_`_----- Number of lines.- _s-_/_-_--_.--_ Lenpgth of each line.._---�______ ________Width,of trench--- -"-------------------- Type of fii#"er material_:�e. -._ . ._ :_De th of filter material-__f�__!--_--_--Total length._.._-...-_____��-_"_____ _ Seepag it: Distance to nearer#'well_/d _ _�Distance f om f unclation,:"' OI nce t } ,/ _..-_.Dista o nearer lot line._. . Number of pits----J�----__,---Lining material. Size:'Diameter.-- De th Cess ool: Distance from nearest well---------------:_Distance from foundation____` __ _--.Lining material------ F_jL Size: Diameter---- ?'=.-----------i--Depth-----------------------.-=-- -----......_)-------Liquid Capacify----------------------------gals. Privy: Distance from nearest well-------....--------- ..----_.-___:-....._...t__Distance from nearest building f Distance to nearesrt-lot line ="' " g ❑ ------------------------------- 1 F Remodeling and/or repairing {describ(e): --------- ------------- -----�-•----- -----•------------------ - I I - ------------------------------•----------------•--------- =-----------•---------------•----•------------------•------------- --------------------------••----------_---------------------------• =------------------------------••------------------------------ ---- hereby cerci that I have prep red Phis applicafion and that the work will be-done accordance with San Joaquin County ordinances, Sta las and[r ulations of the San_ Joaquin Local Health District. (Signed) ff - t ' i I- - , f 9 I ------ ------- wner and/or Contractor) -- - -- - -------------------=--- A { F g -- -------(Tifie) . -- --!= I Pot plan, showing size of lot, locafio} of system in ation to wells, buildings, etc., can be placed on reverse side). - I - t t FOR DEPARTMENT USE ONLY 5 APPLICATION ACCEPTED BY.... ._ ----------------------- ------------------------------- --------- DATI. REVIEWED BY------- DATE It - ------ --------------------------------------------- ------------ ------ BUILDING PERMIT ISSUED------------- Alte. tions an /or r commen tions---------------- - A -------------------------------------------------------- ---..---- .c.... ------------ --- -------- .. __.-....-_... --- - --------- � !""�'. f ------ 4,--------iL"A4-A 13_UL&_:;D-_------------------------- ; ----- 1NAL INSPECTION BY:. --- ------_` - = Date `0_/) _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California + Tracy, California ! E5-9-2M : Revises 1-57 F.P.CO.