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� w APPLICATION" F'OR SAN1TATlON PERMIT . Permit,No �_e in Du '_{CompletDuplicate) II p ) Date ds`sued Application is hereby made to the San Joaquin Local Health District for a permit to constfuct'and install the work herein described. ade in compliance with County Ordinance No. 549 This application is m . I -------s --------•------- ---- •--------•----- JOB ADDRESS AND CAT10N------ -------------- s -- Phone l �- ��F ---------------- ._ Owners Name - -- /L - � A --- --- -- -•--- on - --------•-- -- --- ----- ------ Ph Phone ,2 Name ____________ _ —»• ,+ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ p. -----------•- . ' Number of living units: _ _ Number of',bedrooms .- Number of baths -- Lot size _____� - Y \ IfDDepth to'Water Tab] _4-"ft: I ` Water Supply: Public system [j 'Commuriity system ❑ Private ep Character of soil to a depth of 3 feet:sSand . G�ael ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[I Hardpan [I Nb ew Construction:Y.es;❑ No' FHA/VA: Yes ❑ No ❑ l Previous Application Made: Yes ❑ ;1 . TYPE OF INSTALLATION AND SPE C iCATIONS: tic tank.or`cesspool perm4ted if public ewer�is available within 200 feet.) No sep rs +-... _ : Distance from nearest well_________________Distance(from foundation___________- e ____.---- Capacity.__._.__.--._____ .p its------ --------------�f Size--------=-------- Liquid depth Distance from-neare 'Nn. of tom artmen st well-._� -_____Distancelfrom foundation___—� '----- tante to nearest to#-y1473 isp : s.Y . Len th of eacfi line_-_____-.- Width of #reach_____-__ -� 9- Number of.lines =, --------- g - � e th of; filter material-_----- _-- Tota length------- o of filter material__._ p ' F _ latio A- [` . 'Distnce to nearest lot line-------••-------- --------,Depth-- ---------------------------- Seepage Pit: Distance of pltarest=well- �- Lining material e-from foun S ze nD.iameter__ ❑ I F Distance from nearest well__. :___-___ ___Distance fro.m,foundatio - _�`-' Lining material ___ ___ ____________ _____ als. Cesspool: --------------------------------Liquid Capacity-,:ri g Siie: Diameter "- < ----------------, Depth-------------- - ❑ Distance from nearest well__ __ ___ -. Distance from nearest building Privy: -- --- -- -- - --- -- ❑ : -- = �•" ----------- -Distance to nearest lot line_--__"-:- --- eA ----------- Remodeling and/or repairing (describe);---------------------------------- - ---------••------ f----------- ------ --------••---------------------------------------------- ------------•------•-----•------------- -------•--•--- _t l--------------------------: --------------------------------------- ------ f I hereby certif that I have prepared-this application and that the work will be done in accordance with San Joaquin Counfy ordinances, Staf a and rjjle land regulation of the San Joaquin Local Health District. = and/or tract r d�o on or( g - -- 7- ---- ------- ---- { {Plat plan, showing size of lot, location�of system in relaon wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE-------- ---------- APPLICATION ACCEPTED BY ------- - DATE______ r --� `x� -- REVIEWEDBY- ----'--=------'------------- - - .DATE-------�----------:---- ---- --•------------------------ ---- BUILDING PERMIT ISSUED------------------------ - - -------------------------------- --------- ----------- -- and/or;recommendations::___--:_._------------------ ----------------- ------------------------- ------•---------- ,r -•=------------------- --------------------- r� +: Date_.:_4 — f U---------------- FINAL ---- -- ------------------------------------ T ---- FINAL INSPECTION BY:.__- - �_"=--- `- - - --- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street y Tracy, California Stockton, California Lodi, California Manteca,.California ES-9-2M Revises 1.57 F.P,CO.