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k. � 'APPLICATION -FOR 4SANITATIONt PERMIT Permit N0. ..1 i.�1 -�---- " (Complete in Duplicate) Date Issued /s`� 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 Ordinance No. 549. "WC�T__O, JOB ADDRESS AN -------- - ------------------ --- Owner s Name-------• --- ... --•------ Pho - ?=f'� —-- Address.------•--------------- ------•--- --------=--� _- --------••--- --- --------------•-------"`--'•-------•--------•---------•--------•------••--------•--- Contractor's Name---------- C `' y' ----------------------------------------------------------- Phone i Motel Other Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ ^�`a• ooms _"""" Number of baths Lot size __ - Number of living units: -------- Number of bedrWater Supply: Public system El community system El' Private �epth to Water Table 50__ ft. IV Character of soil to a depth of 3 fee+ Sand [IGravel ❑ Sandy Loam- FHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: I 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I I ark: Distance from nearest welt___""-"- Distance,from foundation Ma'terial----.__-------------_------_-----_--___-----. No. of compartments-------------------------Size------;---------------- -------Liquid depth = Capacity.11- r Disposal eld: Distance from nearest well-_•M------ Distance from foundation"_�_ �_____-.".Distance to nearest lot line--- __.- Number. of Innes"""___"�--------- - --------Length of each line---40 ---------------.-.Width of trench-------=i ._.-•------------------ : r r ,. Type of filter material__ e" v_(1- -Depth of filter material--"__/r�'_______.__Total length------- fi- Seepag,e it: Distance to nearest wel4""�,tJ>3 f "DistancerAom foundation""�(11�?".--_-. Distance to nearest lot line....s""-"-". .� Depth 3 ----- E!rNumber of pits_.""""_/__-- _.""Lining material--� Acle------Size: Diameter.__V? -_._ _ _. p i-- --------- Cesspool: Distance from nearest well----------------"Distance from foundation____.-----"-___---.Lining material"-__"""...""��.________._"----_--_-- ----------Depth_`------------------------------------------------Liquid Capacity---------------------------gals. ❑ Size: Diameter---------------------- ---- i Distance from nearest well------------------------------""___.------_------Distance from nearest building- --------I"-------------------__. Privy: r ' ❑ Distance to nearest lot lire- ----------------------- ---•--------"---------------------- -------------r Remodeling and/or repairing (describIe) -----= -----------------------------------------------------"-------------------- I ----------------- ------------"------•------------------------------------ I = ------- --------------------------•--------- ---------------- ---- -----------------•------------=------------------- - R I i ,I r r = ------------------------------------------------ ------- I hereby certif t i have prepared this application'and tha+`the work will be done in accordance with San Joaquin County F ordinances, teal ws, a d-rules and r gulations of the San Joaquin Local Health'District. € ; �.` i and�or Contractor) ---- -------- - ---- ----------- -- -- �' rr (Signed)" -- -----------------•-- .-..�1'-- - - - --- k „} Title ----�wner ---------------- ............ By•----"---------------------------------------•--------- " __ --------- -- - -------------------- -(Title) (Plot plan, showing size of lot, location of system in relation to Is, buildings, etc.,"can be placed an reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- �;, s - DATE = 5'�o --s - IREVIEWED BY----------------------------- - --------------------------------------------- DATE--------------------.-------------------------------------- --------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------------------------------------------------------- ' '" Alterations and/or recommendations:--_7'_4r-`- - -.-------- I------- -------------------------------- ! - ------- ---------------------•- ----- ---------••----- --"--- ---------- -------------------------------------- ---------!---------------------------------- " - --------------------- �� Gds" ." ` - --------!;--- FINAL INSPECTION BY:" .- ------ ---------------•----- --- Date.... - �. SAN JOAQUIN LOCAL HEALTH DISTRICT ii 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "G" Street Lodi, California Manteca, California Tracy. California Stockton, California � rS-9-2M Revised V59 F.P.Co.