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::FO��ROFHCE SE: _ � ,�, / 4 Permit No. __.. - ! D APPLICATION FC�:R SA'N1TAT10N PERMIT � (Complete �l� .. v _ _ Com late in Duplicate) pate Issued .___......_.; -•-• -- __ ___ ____ ________ -. 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 Count*00rdinance Nco 49. s JOB ADDRESS AND LOCATION-------------------------• Phone.._..._____...- Owner s Name --_-------------- ------------- ------------------•-------- ---------------=-- - Address--- --•-----`'f' • ---- ---------------- one ' Ph Contractor's Name------------ -••• -----••-•-- Motel ❑ Other ❑ Installation will serve: Residence Apartment House C3 Commercial ❑ Trailer Court ❑ Number of living units: _2 Number of bedrooms .,3-__ Number of baths -_:2Lot size .............. - Private ❑ Depth to Water Table __._____ ft. Water Supply: Public system [Community system 11Private Loam Clay ❑ Adobe❑ Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y ❑ Previous Application Made: (if yes,date--------------------I No New Construction: Yes [2�No ❑ FHA/VA-. Yes ❑ No J i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool perm fitted if public sewer is available within 200 feet.) Sept Tankt Distance from nearest well_.__.________-__Distance from foundation Liquid dep*_ _-----eriai---------_Ca-Capacity -------Size-----•-•-------•--------- ----- q R P tY---•--....----`...._.. ) �� No. of compartments-------------------------- i Disp sal . Distance from nearest well_________________,Distance from foundation /47 -------Distance to nearest lot line...--.--••- �A of lines---'------ ---- = Length of each line---------------------------- Number Width of trench......"� - --•-•----• Type of filter material_.._..��I�l-------Depth of filter material____-�-��.-�---7otal length------�-'-�.--•----••-------••- O Seepage Pit: Distance to nearest well_____-_______________Distance from f,�,o,,11unds Zia npip+er Distance to Depth to s`��'....... Number of pits--_jj---------------Lining material.___0- 9 9l ning Cesspool: Distance from nearest well-----------------Distance from foundation ___-----------Liquid Capacity gals. ❑ Size: Diameter---I-------------------------- Depth_ . -•---•- ---------Distance from nearest building-----------•-------•---------•-------•---- ' Privy: Distance from nearest well------------------------------ ----- ------------------ ❑ Distance to nearest lot line----------------------------------------------------- -------------------------------------------------- Remodeling and/or repairing (describe)------------------ --------------------•---•--------••--------------•---- -- ••---•---• . ----------------------- -----• ------ ---------- ------------- ---------------------------------------'---••------•---------- ' i--•----•-------------•----•-------•---------•-----•---------------------------------------------------------- •------------------ ---•----- - I hereby certify that I here prepared this application and that the work will be done in accordance with San Joaquin oun ordinances. State laws, and rules Arid eg tions of the San Joaquin Local Health District. -------------------------------------------------(Owner and/or Contractor) (Signed)Si ) - (Tif Is)---------------------------------------------- ----- BY:-------------------- buildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, cation of system in relation to walls, I FOR DEPARTMENT USE ONLY ------ -------------------------------------- DATE , �, APPLICATION ACCEPTED BY -- - - DATE. -- - REVIEWED BY-----�---------•------------------------------------------ ---------------------------------------- BUILDING PERMIT ISSUED_.--------••-------------------------•-------•------ --------- ---------- --------------------------• DATE----------------------------------------•-------------- Alterationsand/or recommendations:-----------------------------------------------------------------------------------------------------------------------------------------•-------------------------------.----•--•----.----•-------- ----------•-•-------- •-------- - ----------------- FINAL INSPECTION Date- f/ - 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 705 West 9th Street 130 south American street 300 West Oak Street 124 sycamore Street ' Lodl,California Manteca,California Tracy,California Stockton,California � ES 9 REVISED e•59 2M 6-61 ATLAS