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LFR OFFICE USE: �------------ APPL1CATlON FOR SANlTAT10N PERMITPermit Ido.(Complete in Duplicate) Date Issued- - -------------- # __ This Permit Expires 1 Year From ate 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 i compliance with County Ordinance No. 549. ---- JOB ADDRESS AND LOC TI N_ -.--- - .-- -- ------_ ---- Phone_ Owner's Name_---------- l ---• •----"-----------------•--------------------- /.._. Address--------------------------------------�- - � _ f - --- �-=---• Ph no e._�-��.�� -�-� ------ 'I� Motel ❑ Other ❑ Contractor's Name--------------- --"�� Commercial ❑ Trailer Court ❑ � Apartment 17 House ❑ t -_•_______________ Installation will serve: Residence p tJ _,?__�____ ___ __----____ Number of living units: __,I_-__ Number of bedrooms ---I--- Number of bath#o -/-- Lo size _--- f-- Communit system ❑ Private Dep Adobe Hardpan ❑ t. Water Supply: Public system y Y Clay Loam ❑ Clay ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y PHA/VA: Yes ❑ N90 Previous Application Made: (if yes,date------ --- -------- NO New Construction: Yes NO ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I ' r Septic Tank: Distance from nearest wel4_ �--Distance from foundation �p�h--Ma gra----� ----Capauty___-_� I No. of compartments_ Size_3X_,57)( ---•- -- from nearest well -Distance from foundation__._Zb�-------Distance to nearest lot line._H_�--•-- V' I Disposal Field: Distance Len til of each line-__------- Width of trench_"____.__ Number of lines •--------- �} g Tota4 length Q cA A.-Depth of filter material � g Type of filter material_-t7'! Dep l —/?e ----- from foundation____________________Distance to nearest lot line_____ ' Seepa a Pit: Distance to nearest well _ s.� P 2-�-------•--- I Number of pits-------/------------ Linmg+material_s."--- - -- Size: Diameter--____-- Distance from nearest well__.__._-__- ---Distce-from foundation-_-------_---- _-_Liquid Capacity_____--------------------•gals. 1 Cesspool: + Size: Diameter. = Depth � ❑ -----------------Distance from nearest bui4ding----------------------------------------- Privy: ----- -- --"-... Distance from nearest well-------------------------------------------------- 3.... --- ----------------- -Distance to nearest lot line------------------------------------- Remodeling a or repairing (describe}:____- -. `----------------- IfF _______________________________•___•____•_____._-_______•_____•--_----"--------••----------•---•--------•---------_-------______•________________________-___________•__'----------------------- ___-___._______-_.________.--------- M i I hereby certify that 1 have preparedlf the San Jothat i hL cwork al willHeabeDis done n accordance with San Joaquin County ordinances, State laws, and rules and regulations o ( er and/or Contractor) --------------------------------------- ------------- O n �� --- (Signed)------------ -- Title `----- ................ .------ .- -- - ------ ------- By- ----- BY- ---------------------------------------------------------------------( � )--------------- (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ! ----- --------- ---a---------- --- APPLICATION ACCEPTED BY-------- DATE--------- ----------------------•------- I REVIEWED BY------------------------ ----------------------------------- ------------------------------------- - -i ---- -------- -�=-- DATE--------------------------- --------------------------------- BUILDING ---- ------------------------- BUILDING PERMIT ISSUED. ----- �- - -------- .� == ---- = - - Alterations aril/or recommendations:-_ E?� ^_.� tr -------------------- -------•------- --------"----------------I----- ---------------------- __ ___________�_--_...___--_____...___"____._._.__.__- ______-___._ "____--- r f Date..--11415 -- FINAL INSPECTION BY---- - ------------ ------��--- -�---- --""""-- " ., SAN4JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California 1 ES 9 REVISED B-59 3M 3-'63 i.P.CO.