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�r�� er G sti r - - `y. - ` Permit No, -- -- APPLICATION FOR S'AMTATION PERMIT 1 =: 16 (Complete in Duplicated pate Issued ----------------- { This Per Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Health District ffoonce gr a permit to construct and install the work herein described. This application is made in compliance with Count y JOB ADDRESS AND CATI N-_.---- ----` - 2 -- ----- ------• -------------� tPhone------------------------------------ Owner's Name------- -- - -------------•---•--•--•----------•------------------- I Address--- __ Ph Contractor`s Name____________ ___ i = { Motel Other ❑ artment House ❑ Commercial ❑ Trailer Court C1 ❑ F Installation will serve: Residence [[f - Number of living units: •_ _ Number of bedrooms .- ,- Number of baths _. "_,.Lot si Ye __ ��-- - ,,.. i X,. Private Depth to Water TableJ� ft. Water Supply: •Public system [j��t-ommun;ty system ❑ ❑ i p I Adobe �Ha dpan ❑ 1 '$ Clay Loam ❑ -Clay ❑ Character of soil to a depth of 3 fee+: Sand ❑,�Gravel 0- Sandy Loam ❑ Y ��A�VA: Yes ❑ No ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes I No ®/ I TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) .= is a k Distanf e from nearest well__-______--__--_Distance from foundation Liquid depth---------------------- No. " -- Capacity__-___ ._-_______-___ No. o ,compartments___-- -- ------Size- -------------- - q .,._.� . Q .___.Distance to nearest let line_��_- ------- Disposal i Distance fromInearest well _ Distance from foundation__- r t _/F _- --Length of each lin ____ --0-__-----_---Width of trench___-_�.1C�-------------" lJd' IV Number of Fines---------- -------- g feria_ Total length_____-!---•-------------------- s Type of fiiter material-_�`_ ---- -• Depth of r Distan f o ou catioF�---±'Distance to nearest lot line_._ ------- G Seepa it, Distance to nearest well S =Diameter--- --------- Depth......rye.- --- } of pits-------/- - - - - Lining materi 1---- -- - I / Cesspool: m nearest well-----------------Dista ce from ndation___________ ------- Lining materia4_-"_.__.._------- ---------"�-.els. Size: D timet Depth " ------Liquid Capacity----------------------------9 ❑ er-------------------------------- p 1i -Distance from nearest building------------------------------ ---------- Privy: Distance from nearest well._-__.--__-...--____ ------- ----------------------- ------------- Distance to nearest lot ine------------------------------------------------------------------ El - - ------------------------------------ Remodeling and/or repairing (d iscribe)-------------------- ------"------- ------ = =-1 \ -------------------------=------- ----------------•---------------------------------t� - --- ------------------- ---------------- =----------------------------------------•-------- - ---------------------- -- cc r e - --- -- - I hereby ce {fy hat I havelprepared this ppllf the Sand that t Local kHealthei)i}r{�}n accordance with San Joaquin County ordinance Sta. .law , and rule"s nd regula s M" Owner and/or Contractorl ---- ---- --- -- 5i (Signed) -h!T - 9 l }, -----------------(Ti+lel L -- -- ------------- -1 (Plot plan, showngsize of lot, Iota+ +em in relation to wel buil ings, etc., can be placed on reverse side). Rp1PART NT USE ONLY ----=- ----- ------- "--------- ----- ------------------ ------------- DATE----- �'�- ---�- -'-- ----1 ---------------- -- APPLICATION ACCEPTED BY _ DATE-------------------•--------------------- V �-_____-___ REVIEWED BY-----------'---------------------- --- F_: .------------------------- BUILDING PERMIT ISSUED-------------------------------------------------- Alterations and/or recommendations:------ ------------------"------------------------------------=----------- 14 - ----------------- ------------------ - ---------------------------- -------------------------------------------------------- l_ -- . e_ _ - � 11.7 •------- ------------------- ------- ----------------------------------------------•----•---- ---------------------------------- Date IG -_G FINAL INSPECTION BY:---.-.-,. ----- '---- - -- - ------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West oal Street Tracy, California Stockton, California Lodi, California Manteca, California ES-9--2M Revised 8-'S9 r.P-Co. - _- -_. - -