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��L� �, Permit No. _..l-.l.�--•--•- 42 a. 'APPLICATION F0k'-4ANITATION PERMIT ( • 30 (Complete in Duplicate) Date Issued __s_._�,(-.7-`•-{O This Permit Ex� iris 1 Year From Date Issued Applicationry is hereby made to the San Joaquin Local Hdealt cDiNoC f or a permit to construct and install the work herein described. This application is made in compliance with County Ornae JOB ADDRESS AND LOCA ION_________._ - � - ------------------------ - �_ qy / , .� hone Owner's Name ,�lCc - -- .......... + t l ---------------------------------••--- Address__ -----• ------- one --- b -- _ - ----------------------------- Contractor _L / Ph 's Name_. _.__ --------------- f,, Motel Other Commercial ❑ Trailer Gourt ❑ , ❑ Installation will serve: Residence .�/Apartm 6t House ❑ ` �� Number of living units: __/_ Number of`bedrooms __ -- Number of baths __._..__ Lot size __ -- Comrrtiunit system ❑ Private [�DePth to Water Table ��--�5- ft. Water Supply: Public system ❑ Y Y Hardpan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Previous Application Made: Yes ❑ No�[�New Construction: Yes ❑ No 1� FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material_.__-_.._____-.__.---- Septic Tank: Distance from nearest well--___.----_-_--_Distance from foundation--------------------- No. of compartments -----------Size_---•---------------------- Liquid depth Capacity 11 r Dis El F' ld: Distance from nearest well__ ------ DistanceK.r.0 foundation._--_!.a--------Distance to nearest lot line._i5 P Len th of ach line ._/- ------------------Width of trench--_-e�- ------- l Number of lines-------- ------- g Depth of filter -------- Tofial length----------tea Type of filter material__- P . t+ i Distance to nearest ell,1 + ----------Distance m f unda Ion__ a--- -.Distagye to nearest lotsne _ .SD 0 Seepage t: S¢e: .Diameter__.- . Depth_-_a w / .Linin ma�erial__ .- ---.- - -- Number of pits------ --------- ---- g ------------------------------------- ---- __ _______ ______ t ----------- 1 ing maleric Distance from nearest well------------Distance from foundav4In__---, Li`nuid Capacity gals. l Cesspool: - q P ty------------------------- ❑ Size- Diameter_ Depth-------------------------------�----- ----• Distance from nearest building----------------------------------- ----- Privy: Distance from• nearest well--- -h-1 �--------------------------------------------------------------- ❑ -- --------------------------------------- Distance to nearest lot line_--,_------ II _ i -------------------------------- ----- ------- ------ ------- ----- -- -- --- Remodeling and/or repairing (describe):----- - ---- ------- ------- - _ ---------------------------------------------------- ------------- - ;. ---------- --------------- ------------------- --- --------------------•-------------------------------------- ------------------------------------------------------••----------------- ------------ ---- ----- ---------- lhereby certify that I have repared this applicatio and tha +the work will be done in accordance with San Joaquin County }a laws, and rGles nd regulations;of�h, San 16aquinb cal Health District. I ordinances, S j i It -- .-(Owner and/or Contractor( 1 u-�------------------ - - - ------------- ----------------=----- ------ - Si ned ------- ------------------------------ e- s (plot plan, showing size of lot, location of system in aton to wells, buildings, etc., can b paced on reverse side). FOR DEPARTMENT USE ONLY ------------------------------- 1 -----i------------ . , DATE--- t ^ APPLICATION ACCEPTED BY_ '; . .RATE- - - - ------------------------ - REVIEWEDBY---------------------------------------------- -------- - -- ---------.........-------4:,DATE------------ -------------------------------- --------------• BUILDINGPERMIT ISSUED------------------------------------------ ------------------------- - -------- =----------•------•------------------------------------------------ ------------- - -------------- ----- Alterations and/or recommendations------------------ -- ____.____ ----------- ------------------------------ -- - --- -- -- --------- ---- - - -- --- ------------------ f - --------------------- - --------------------------------- FINAL - ----F1NAL INSPECTION -- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 300 West Oak Street 132 Sycamore Street 130 South American Streat Lodi, California Manteca, California Tracy, California Stockton, California ;i,� ES.9-2M Revised 0.'59 F.P.Co. -