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FOR OFFl USE : ` ! f0�1 .. ----------- APPtICATlO R SAN17A710N FERMIS Permit Na. ...-• - bate Issued .---- -- --- --- ----------- ----- (Complete in Duplicate} --------------------- --------- . -- •- --- -------- - This Permit Ex fires 1 Year From Date issued hereby made to tiie San Joaquin Local Health District for a permit to construct and instal4 the work herein described. p,pplic plic is he y This application is made in compliance with County Ordinance No. 549. `��/� - , . � .-- ,- - JOB ADDRESS AND LOCATION-. •----; hone-------------•---------------------- ��t�� -------------- ------- ----- P �` --- l. / e ------------------ -----•--- -----•--------- Owner's Name-------- � �c-�.� y ------ one ` -/__.---- •------- Address ----•----•-----•----- ------ -- -- ------ Contractor`s Name. -.--------•----• -� - ----------- ---------- Motel ❑ Other ❑ t Apartment House ❑ Commercial ❑ Trailer Court ❑ Installation will serve: Residence P f - -------- Installation --_._ Number of baths ---/---- Lot size --c�--. ' Number of living units: .-j'---- Number of bedrooms�� t of Private ❑ Depth to Water Table..P__ ft. Public system ommunity system ❑ Adobe ❑ Hardpan ❑ _Water Supply: Gravel ❑ Sandy Loam Clay Loam ❑ CIaY ❑ y Character of soil to a depth of 3 deet: Sand ❑ l No r,/ New Construction: Yes ❑ No �HA/VA: Yes ❑ No Previous Application Made: (If y es,date.-------- 1i' TYPE,OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Se tic Tank: Distance from.nearest well----------------=Distance from foundation-___.---.----•... ..Material-_____.----------:. i --•--Li Liquid depth--------------------------Capacity----- ----' ----- --- p � � No. of compartments_-.�.:�..-----_-=-=`-Size'---�------� -----== q t,,. .., stance to nearest tat line_j-------------- /- - --"ii---.Width of trench-- ----"/ ......... --------- b Disposal-Fi d: Distance from nearest well-.. - -.Distance from foundation -__. -f Number of lines--------=--- � Length of eat Mine- Total 'length_--------------"f-= go ! 1 p Distance�tto nearest, line_."-------- Type of filter.maenal._.1 :-Pry -Depth of filter matenal :__ -- ! # T t i , r� De t'n-._. � Distance to nearest well--_f.---------- ;Distance from foundation_.__./ p 'Seepage Pit: � w, Number of pits.__._.--f__-_--- --Lining material:_-/ : Diameter .- - S �" Distance from nearest well----------------Dis#ancre from--foundation__----------------- --- --. -------Liquid Capacity_ .=--=i------- --------gals. C esspool: it De th=._-" a ❑ Size:-Diametei___.-------- p Distance from nearest building-- ---------------------------- 1 Priv Distance from nearest wel--------- ---------------------------- /i y. -----..---- --------------- 4 ❑ � � Distance to nearest lot line----------------------- f ---------------I----------------------------------------------------------------- Remodeling and/or repairing (describe):-------•----------------------- }. ------------------- -._ ---------------•---- ---- _ --•----------------------- 1 --------------------------------------------------- --------- - ----- ----- - --- y" application and that the work will ,be done in accordance with San Joaquin County I hereby certify that I have prepared this ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Owner and/or Contractor] { VA-(Signed}---- ^' ' Q'3 ` {Title}-------------- __J_._. ------- --------------------- ------ BY---------------------------- - - ' --------=--------------------- -------------------- ------------------ Plot plan, showing size o{ to}, location of system in relation to wells,'.buildings, etc., (Plot be placed on reverse side). FOR DEPARTMENT USE ONLY .,.:�/. -------- ---`------ ------------------ � DATE------ - =------ - . --------- ---- -- ------------------- ----- --------------- APPLICATION ACCEPTED BY-._.._ -____ -------__ DATE___._.-_ __________________ REVIEWED BY------------------------- -------------------- ------- ----------- -- ------------------ BUILDING PERMIT ISSUED--- �..................... ------- -----=-------------- -----------.------ - ------------ ------------- . ----- "•r Alterations and/or recommendatio�ts:____-„� " 2ct .�-s�T._ - a - ---L�-� ---------------------- ------- _ -------------- ----------- � -------- .- 1 62 ---------- ---t� i ----- _ . Date � --� �, FINAL INSPECTION BY:..--. '- ;�.w— SAN JOAQUIN LOCAL HEALTH DISTRICT 124 sycamore Street 205 West 9th Street 1601 E.Flaxalton Ave. 300 West Oak Street N19nteca,California Tracy,California Lodi,California Stockton,California E5 9 REVISED a-sq 3M 3-'63 F.P-CU, '