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FOR OF I I C EUSE ............ APPLICATION FOP, SA'1`4ifATION PERMIT Permit No. ............ ................(Complete in Duplicate) 1. ......... ........ This PermitDale Issued lxpires. I Year From Date ISSUed ?his is hereby made to the San Joaquin Local Health Dis-11rict for a permit to construct and install the work herein descry d. 4his application is made in compliange with County Ordinance No. 649. 0 S"47 - I ef-0 -,?-S JOB ADDRESS AND'LOC c�------- Owner's Name........-------- Phoneof ......... . ... . ...... Contractor's Phone ... . ........... . ......... ...... ............ Installation will serve; Residence @ErApartment House[] Commercial E] Trailer Court Fj Motel 0 Other Number of 11ving units. ./.. Number of bedrooms J.. N, umber of baths I? Wafer Supply: Public systemCommunity 0 Lot size/AVI�KV?1410 , n C] Cornmun ity system [] Private 94"Ibepth to Water Table alp ft. Character of soil to a•depth of 3 feet: Sand El Gravei 17 Sandy Loam 0 Cioy Loarrij] Clay E] Adobe ardjpan 0 (Ell Previous Application Made: fli ye's,dote ......... .... No E�' New Construction: ye's, 2qi-!`Zb F -I FHA/VA-. Yes F.,6.—No [-I TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank Or cesspool Permitted if public sewer is available wifhin 200 feet.) Septic Tank: Distance from nearest well..,"_ Disf Me" a from No. of 'Size ::;I Wrl-cuid depth.--l-K Disposal Field: Distance from nearer Distance from Z iounoat'ion ... . .. ....... Distance to nearest lot line,47... Number of lines..... Z A j Z....Lengfh of each I;r,,e, nch 1010--o ;00"0. of trq Typo of filter material -90; ... Dopfh of filter material., T ota! lerlg�h. Seepage Pit: Distance to reams' well. gol Distance_'if fou r to neared lot S,zr-: Diamelle;, - plumber o� Pifs_;� ...... 44 Deptw Cesspool: Distance from nearest well„......_.-._. Disfance from ioundatioi ....... ....... .1ining D�amet O*r ......... __ ....... Capacity__ ...... - Distance from rearest ....... ..._,Distancs from nearest building ................ . Distance to nearest lot line__,. ... . ........ Remodeling and 'or repairing ........ . . . .................. -.-.1- ........ .......... I— ...... ........ . ..... . ........ ........ .............. ..... ............ .....__ - — — ----------- ...... ....... _ 4C ............ -------- __I......... ........ ........... ...................•--......_._..._.............. .............. . ......... ............ 11 ................. 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son joa ordinances, State laws, en � rules and regulations of the San Joaquin Local Health District. �qujn County I .. I �)p (Siginad)_ Z j2kw . ........ . .. ContractorL . .................. * .. ...... (Title) ........... (Plot plan,showing size of lot, location of system i alafi*n to wells, buladings, etc., can be paced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y_......._...... ........ ..... REVIEWED DATE......:. BUILDING PERMIT Alterations a9lor recommendations:...-. ...... ;-:w I - --------- ......... .......... .......... .. . . . ............. .. . ........ ................ ............. ...... ............ . . . . ........ .... . ....... ........... ......... .... . ........ ... ...... . . ..... .............. ....... . . ....................... .... . . FINAL INSPECTION BY... Date........- SAN CAQUIN LOCAL HEALTH DISTRICT 1601 E. "asolton Av*, 300 W St Oak Straw 124 Sycamore Sites! 203 West 9ih str4tal S1otk1*ft, Calijot"ja Laidi, California Manteca, California Tracy, California P,Rca.