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Permit No " s FOR =11 � °q " r - Fn_R"SAN{TAT{ON PERMITAPPL1CATlO.N :Cr �1eeii Duplicate) Date Issued .:__. _.. ...-•--- cpThis Permit Ex rtes 1 Year From Date issue { permit fio construct and install the work herein described. I Ordinance No. 549- . ,ration is hereby made to the San Joaquin Local Health Distric or a Appli_ This Pp �a llcatian is made in compliance with County V_4��:•-_••_•-•-_-_-__•_-.•............. � SOB ADDRESS AND LOCATION-__ Name_.-_--- - -••• ..._ owner's -- -------------•----•--------•------...-----�•---------•-----•--------•----•------•------•-------•-- phone.--•---••----•----•-••----•-------• I Address � Q "f ---- ................. �: ! Motel ❑ Other ❑ Trailer Court ❑ Contractor's Name---- . - Apartment House ❑ Commercial ❑ Jt Installation will serve: Residence Number of baths _�_.- 'Lot size Number of living units: __�_._ Number of bedrooms �De tth�to�Nater Table �1V ft• I Community iy , priv 'ts❑ p - Clay Adobe Hardpan❑ stem ❑ stem I Water SuPPIy: Public sy '"� Gravel ❑ Sandy Loam❑ Clay Loam❑ Y ❑ ' New Construction: Yes �No ❑ FHA/VA Yes ®' NO ❑ Character of soil to a depth of 3 feet:� Sand ❑ � No [� Previous.Application Made: (if yes,date-------------------- TYPE OF INSTALLATION AND�SPECIFICATIO ub5 tic sewer is available within 200 feet.) r 4 [No septic tank or cesspool if public Material-_ - • Distance from nearest wa4__.- ---'-Distan a/from foundatiLn_ui� dep�h"___ ___ Ir Capacity... .f,t . SFptic Tank: Size_-�,fP-x-- = q No. of compartments__.._ _ -"-- -- 1 i • .. . l Width of trench----- -----;T Distance from nearest well Distance {tea�`u1e atIOT1��••��---=:-•--Distance to nearestlot me-- •-••-- t Disposal Field: o �i Number of lines-----A��-_-------r--- TotaV length a�- o T e of filter material. -�+ - -;-Depth of filter materia •----------- ,. Y' -f_ Qe th.-- -�------_------•--- Distance to nearest well___._____.--•- ==- I.-Distance fr m {O nay zle:nDi Diameter �` to nearest lotline- Ty, ine................. I Seepage Pit Linin material__// W� Number of pits_--- --- 9 ' gals. Cesspool: Distance from nearest well----------------;. hce from foundation -----=.------:--Lieu d Capacity--- _.----••— P ❑ Size: Diameter------------ ---------------- --... �-----------------------------Distance from nearest building -----•---•--•-...._.._. 1 Privy: Distance from nearest we =� ------------- l ❑ Distance to nearest lot line----------------•- ----•---- - ---------- 4 --•----- Remodeling and/or repairing (describe)------------ -- ' - --- "- ---__ '. ------•-----•-----•- t ty -----•.-------------- ---•------------•----•-----'------""-""•--•-- -• ----- � application and that the work will be done in acco'rdance with San Joaquin Dun I hereby certify that ! have prepared this app 1 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. l [ Sr Contractor) • - •--- • •------- - J --- (Signed) Title _ BY=---•------•---_---- •-----•----•---- -•----- -- - --'- lace ;averse side}. _�. [Plot plan, showing size of lot, location of system- relation to wells, buildings, etc., can.. e_p FOR DEPARTMENT USE ONLY DATE---- ^to z—•••--------------•-------- APPLICATION ACCEPTED B ----- -------- DATE---- ----•------•--------------•------•--------•- 1 REVIEWED BY------------------------•-----•------------------- ------------------ •--------- -------- ------•-------------------••----- --•----------------------------- BUILDING PERMIT ISSUED--------------------- `s� '� �".___._--_..�4- • �.1a_S_ ..+-ro Alterations and/or recommender ons:_.. .__�9_--- - --- ••_..--•...---•---• .;? ---- - ,� c G - r- - Date__.--- FINAL INSPECTION BY:..._ _ --- �' SAN JOAQUIN LOCAL HEALTH DISTRICT ' ! )124 Sycai"no%a�Sir�at 205 wast 9Th Strati 300 Wast Oak Straat r' Tracy,California 134 South American street montac�,California Stockton,California Lodi,Colifo�nia Cid EB 9 REVISED 5-59 2Ml 6'451 ATLAS