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Permit Na. - -------- -------•----- APPLICATION F'ORSANITATION `PERMIT (Complete in Duplicate) Date Issued - � ' - r 'cation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Apph inance No. 549. I This application is made in compliance with Cotunn y -- -- -------------------------------------------- ----------'---------------------•--------- --------- JOB ADDRESS D LOCATIONy ry I Phone-.C:;5, ---------- -- - Owner's Name_ - - - ---- •, ----- -------•-------------------------------- Address----- -0j---- - s --- ------ ---- --'--•-------•-•----- --- -------------- --------------- Contractor's Name-- -------- ----- Phone Motel Other [� r Rti�r�t'^l�ioIse ❑ Commercial ❑ Trail Court ❑ 1❑ n!Installation will serve: l�esitle'nc`e9 -11__________________�-_-_ Number of baths __ __-- Lot size _"---- -•--- Number of living units: _I-___- Number of bedro - Depth,,to Water Table ___-___- ft. er Su l Publiclepfh ystem [Community systePrivate ❑ Wa+ pp Y Sand Lo2�'N, Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a of 3 feet: Sand 0- Grave ❑ Y Previous Application M�de:4(ees +❑ ,Noo IV Ne,j Con1fruction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: f o septic tank or cesspool permi+ted if ubl'tc se or is available within 200 fee ) (N p .. sten I j - - " -----�ci --- --- ------- &"- 4 efro fours' tion-'.--------- Ca aSeptic ank: Distance from nearest wel _ ----- Liquid depth'- f�--- pY No, f compartments------------ ► •1Z I ----- istance from foundation"__T _ stance to nearest lot lin ---'--------- Dispos Field: Dist nce fro e e _ e, Width of tre ---- - t- ----------- l Num er of lines Length of each line------------- ' Total length___.______ Type of filter mat '/ ��-----Depth of filter material____"___.-" Seepage Pit: Distance to neare t ell-_______"----------mDtea i e from foundszlepDiameter_--Distance toDneeptest lot line----._:_------- I1 ❑ Number of pi ts-__-__- -___-:-----Lining Distance from nea st well-----------------Distance from foundation_--_____-_-.__-__.Lining material-_--____-__________--------- "els. ` Cesspool: --_-Liquid Capacity----------------------------g 1 ❑ Size: Diameter----- --- ---------------- Depth Privy: Distance frorri near st well Distance from nearest building.______________________"________.-__-_._. ---------------------- ------------------------ ------------- ❑ Distance to nearest of line----------------------------- ,. lZemo lin nd/°r rep vin C e cr e] ------------- ----------------------- -----------•--------------------------•- -------- ---- ---------------------------------- ------------------------------ -•---------------------------------- ---•--------- ----------- ---------------------------•----------------- - I hereby certify that I have prepa+rgulafisons dsapplication the San Joaquin the workcal Heall be clon in accordance with San JoaquinCounty ordinances, State, laws, and rules an (Owner and/or Contractor] (Signed)- Tale{ .Sy------------------ (Plot plan, showing sixa of lot, Iota+item in relation to wells, buildings, etc., can be plata on reverse side]. FOR DEPARTMENT USE ONLY DATE"--------------------- APPLICATION ACCEPTED BY-- --------------------- -- -- --- - DATE_- -- -------------••-------•-------- ----- REVIEWED BY------------------------------- �----- -- BUILDING PERMIT ISSUED ------ DATE ----------------- Alterations and/or recommends+ions:__-___-------------------------- ____.----------------- - ------------------------ ----- - ------------------- FINAL INSPECTION BY:_ -----------------F J SAN JOAQUIN LOCAL HEALTH DISTRICT <11 914 Borth "C" Street 300 West Oak Street 132 Sycamore Street 130 South American Street 1 Manteca, California Tracy, California Stockton, California 4 Lodi, California ES-9-2M 10-52 Revised W-2100