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FOR OFFICE USE: J ANITATION PERMIT Permit No.� APPLICATION FOR S (Complete in Duplicate) ------------ ------------- -- Date Issued ---- 1V6 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 install the work herein described. This application is made in compliance with County in No.r 549. 901, JOBADDRESS AND1OCAT1ON..._,3_,4_#---- --------- --------------- - --------------------------------------------------------------------------------------------- ----------------------------------- Phone------------------------------------ Owner s Name-- ------------------------------------- -- -------- ------------------- --------------- ------------------------------------------------------------------------------------------ A ----------------------------------------------- Address------ --------------I k --------- Phone_______________._.:____..____.-___ ---------- ------------------------------------------------- Contractor's Name_.. Motel El Other [I Installation will serve,-. Residence Ck-._Aparfmenf House [] Commercia.1 0 Trailer Court E] Number of living units. I---- Number of bedrooms _X_ Number.of baths /------7 Lot size ----------------------------------------------------------- 4 Water Supply: Public system 0--community system n Private F] Depth to Water Table ------- 0 ft. Character J soil to a depth of 3 feet: Sand Ej Gravel E] Sandy Loam [I Clay Loam El Clay E] Adobe EJ'Hardpan ❑ FNoPrevious Application Made: jif yes,clote---------------------I No F'� New Construction, Yes_,U!j,`No El FHA/VA. Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-if public sewer is available within 200 feet.) Distance from nearest well----- ------Distance from fo�undation&........-------Maferia-------------------------------- Septi nk No. of compartments----A7 Size Yd--V-9------_Liquid clepth----:75�.......... ------Capacity---- -------- ----- ------------ - r e �,T_ DisposeField: Distance from nearest well___'".-_-...._Distance from founclation-Ja-----------Distance to nearest lot line----------------- ----------- Number of lines.:1------------ --------------Length of each line--_ _Dd__1---------4-----Width of trench-_------- ___.----------- N1 L/ --------------------------- length----- Type of filter material, ?SC-A-------*Depth of filter materia 7 r D nearest lot lin --_-----_------ Seepav Pit: Distance to nearest well----------------------Disfante,11W foundation--/O------1"`"M�%stance to Number of pits.___J--------------Lining material......I-r ��f RSize: Diameter___- 03-------.Depth-- _0; ------ -------- i -------Lining material____.____.--.____________-___________. Cesspool: Distance from nearest well-----------------Distance from founclaton---------- Size: Diameter------------- ------------ ---------Depth---------------------------------------------------Liquid Capacity------------ ---------------gals. Privy- Distance from nearest well-__-_._-------- -----------------------•`-----Distance from nearest building------------------------------------------ Distanceto nearest lot line-------------------------------------------------------------------=----------•-------------------------------------__--------------------- Remodeling and/or repairing (descr;be):-- ---------------- - ---------- -----------------------------------7 --------------I------------------------------------------ --- -------------------------------------------------------------------------7----------------------------I----`------------I-------------------------------- I� .1 ---- 4....... ---------------------------------------------------------------------------- --------------- --------------------------------------------------------------------------------------------------a--------- ie ------------------------------------------------------------------------------------ ------ ---------------------------------------------------------------------------------- ---------------------------------------------- I hereby certify that I have prepared gfa ication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule's and regu i of f " San Joaquin Local Health District. --------------------(owner and/or Contractor) (Signed)------------------------------------- ----- --- --- ----:----------- ---------- --------------------r------------------------------------- --------------------------------------- ................ By:--------•----------------------------------------2--------------------------------------------------------------------------------(Title) (Plot plan, showing size of lot, location"of system in relation to wells,.buildings, etc., ca I n,be.placed on reverse side). FOR DEPARTMENT USE ONLY DATE---- ----------------- -'!- ------------ ---------------------------- t -------------------- ------------- APPLICATION ACCEPTED BY--- -------------------- PATE----------------------------------------------------I---.. REVIEWEDBY------------------------------------- -------------------------------------------------------- ------ ---- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------- -------------------------------------------------------------------------- n (9_!_L:P-----------I..... .... ------- ---- --- --- ---------- Alt tions and/or reco mendafions:. _#4 . - ------------------------------------------------ ---------------------------------------------------------------------L----------- _4 W- ---------------------42-1-4 .......... _ ------------------ ------- ----------------r--------------------------------------------------------------------------------------------------------------------------I------------------------ ----------------------- ---------- ---1-1-------------------------------------- -- -----------------------------------------------------------------------------------------------------------------------------------------:------------------------ ------ --------------------------------------- ------------------------------------------- ------------ ---------------------------------------------------------------------------- -------------------- -------------------- -----------------r-------L------------------ FINAL INSPECTION BY:.... N --- ------------------------------------- Date-----t. .. . .. ............. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Es 9 REVISED 11-59 3M 3"63 FJ-40, AWL.