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FOR OFFICE USE: Permit No. -------------------------------------------------------- APPLICATION F(>R SAAI_SITATION PERMIT --------------------------- t Completi in Duplicate) Date Issued ........ ---------------- This Permit Expires 1 Year From Date issued --- --- ------------------ ---- Joaquin Local Health District for a permit to construct and in all the work her described. Application is hereby made to +he San.Joaq 9,66- vjl(e, 1�1) This application is made in complianciii'with Counil ordinance No. 549 6 .,'.[ Y") 191 ------------ ------------An 4 f e.-A0_- &AIT_.47 JOB ADDRESS AND LATIPN�--.. ----r - ----- -------- Phone....0!!�_ -•4z e ---- - ------ ---- ------------- e V-------- ----------------- Owner's Name______________-- --- ..................................................... ........... ........ ..I_.1'M_., ------ Address---------_------------- Phone......_ ........ Contractor's Narne-----------•-------------------- motel 0 9ther 0 Apartment House 0 Commercial Trailer Court 11 —I Jy-v Installation will serve: ResidenceXI 7 - --. ----# Number of living units: -------- Number of bedrooms -3w- Number of baths Lot size 5w) $_Y_ I Water Table#.<7ft. system 0 Community system El Private Depth to Water Supply: Public x lay Loam D Clay 0 Adobe Hardpan 11 - Sand [j Gravel 0 Sandy Loam D C X Character of soil to a depth of 3 fee;. i YA ❑ NoX ion Made: (If yes,dcite-------- ......) No New Construction: YesX No El FHA/ Ye [-1 Previous Application A TYPE OF INSTALLATION AND SPECIFICATIONS: is available within 200 feet.) (No septic tank or cesspool permitted if public -------Material .............j nearest well ;ewer ------- ........ e from found9tio Septic Tank- Distance from ne Capacity...V-04g. I K /_-Liquid dVh_ No. of compa me I, Distance to nearest lot line...,/A....... rt nts-------- orn foundation Disposal Field- Distance from nearest ----75 -------Distance fr -_---z Length of each line---m------- Width of trench ---------- ------- ii&epth of filter .......... Number of lines ' material----- -----------Total length--------- 6 Type of filter m�aterial__.�iep----- e to nearest lot line___.._._____...._ Distance to nearest st well -Distance from foundation....................Distanc Seepage Pit: Di --------------w----- --Size: Diameter_----•---------- ------Depth-----------_-W-------- ......... Number of pits--I-•-----------------Lining material.. 0 ------------Distance from foundation._-----.-----------------.1-ining material------------------------------------- Cesspool: Distance from nearest well_________________Distance ---------------------__gals. 0 Size. Diameter.-. ----------------------------------Depth-----------m---------------------------------------Liquid Capacity. ..-Distance from nearest building--------------------- Privy: Distance from nearest well_________________________-.-- --------------------------------------------------------- ......------- 0 Distance to nearest lot line.------------- ---M--------M-------- ------------- I C: _51� � ---------_-------------------- Remodeling and/or repairing (desc6be)--------------••------ -- ------ --- ----------- ----I - M.................... ------ ----------=---------------- ------ --------------------------------- ---_-------------------------- ---------------------------- --------------- I -- --------------------------M----------------------------------------------------------------_ ------------•--••--------------•--------•----•---. ....----•-------•. ------------------------------- . ................................ ----------------------W--------W------------------------W------------------------------M-------------------------- ---------------- --- ------ --------- -------------------------------------------- --..t-his-application and that the work will be done in accordance with San Joaquin County I hereby certify that I have prepared d regulation o the San Joaquin Local Health District. ordinances, state I and rules an regu:1daHoA,.nH.. � I k 4. ------ ------------------------------(Owner and/or Contractor) ....... ...w.... ..............._---- -------- (Signed)..--- -----------------_--------- --- ----------------(Title)---------------- BY:........................................I---------------- -------------_--------------ells buildings etc., can be placed on reverse side). (plot plan, showing size of lot, location of system in relation to W FOR DEPART ENT USE ONLY ---- DA ...APPLICATION ACCEPTED BY_ -----••-------------------- - W......... REVIEWED BY----------- - -- ----- ---—----IC� ------ -- ....... BUILDING PERMIT ISSUED------ -- recommendations:: ----------- Alterations and/or t'i ;P ----- ---------------------------I....................................................... ----------------------------------------------------- ---- ... ------------------------------------------ ...... -------------------- ................. ----------------------------------------------- ---------- --------------------W-------------------------------------I----------------------------------- -------------- .................. --------- ------------------------W- ----------------------------------W----------------------I.,------- ............M....................................... I ----I.......W-----------------W-------M------M----------M----------------------------------- ---------------------------------------- ---------- --------------------1------------------- ----- --- ----------- FINAL INSPECTION B . ..... Date..--- ---- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 9th Street 130 South American Street manteco,California Tracy,California Stockton,California Lodi,California ro 9 REvIsED 111-119 21A 5-61 AILAS