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FOR OFFICE USE: <br />------------------- -------- ---------------------------- APLICATION FOR SANITATION PERMIT � I permit No., ...... <br />------------------ --------------------&- <br /> ---------------- <br /> -------------------------- ---- (Complete in Duplicate) Issued '.: �16_ <br />----------------;------- Date <br /> From Date Issued This Permit Expires I Year I <br /> j. ApplicatiorMsherqby made to the San Joaquin;. <br /> Local Healfh District for a permit to construct and install the work herein described. <br /> This application 4s,inade in compliance with County Ordinance No. 549. <br /> �J..JOB ADDRESS AND I LOCATION------- ......! x// 2 ...... . ..... ....................... <br /> -------- <br /> -------------------------­-- --- - ........................ <br /> Phone. <br /> Owner's Name....-------•........... <br /> ........................ <br /> Address-----------•---- ------ ..................4kea-------- ------------------------------------------------------*------------ <br /> ........... ....:._.I..................... <br /> - ---------------- Phone_.... <br /> -------------........ <br /> Contractor's Name__._. _j?....................... .................... -------------- <br /> Commercial Trailer Cou�0 Motel.[],,,Pf <br /> • Installation will serve:7-Residencgo .Apartment HouseE] _[].j " . _ - 9 i r <br /> I\". U-m- --."f - 2 ........ <br /> Number-of-living.-units:-7.;?—:: Number-of­bedrooms­:--3:7-N ber 6 baths -------- Lot size -------- --------- <br /> Private K Depth to Water Table <br /> Water Supply: Public system"El Commuriity-syste.m 0 <br /> Character of sail to a depth of feet: SandE] Gravel [] Sandy Loam E] ClayLoamCl Clay t@ Adobe Hardpano <br /> Previous Application Made:-(If yes, No 0 New C.onstructions-;,-Yes-[D-No-0 FHA/VA: Yes 0 No El <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic TanO,: Distance from nearest well' *Distance from,-ioundation------ V_ <br /> ---- ---.,-,.Liquid depth--------------------•- Capacity---_-------------- <br /> Nd. of compartments------------c7--- Size-_ I ------ <br /> Distance f,rom nearest well_� -�-----Distance from fJmdjjt—jor, _/_ __-_-_._'1.Disfanc -nearest l6t line.0 <br /> dip gel .. - <br /> Number of 6-------------------Length!cf-each line-------------5.c,... ......Width of french------- <br /> Nterik.7 -----Depth of filter material----- 9 . <br /> Type of filter-ma 6 Total len th........ <br /> 6� p <br /> Seepag P'. Distance to nearest well---------_____________Distance from foundation................-_Distance to nearest Ibf.fi . <br /> ne....... -------- <br /> El e 11: Number of pits-------- Lining material----------------------Size. Diameter-----------------'-;__.Depth-----k------------------ -------- <br /> Cesspool: Distance from-,,nearest well--------------_-Distance from,fp�jlnclation---------------------Linin6, i;aterial--------- ----------I...... <br /> ? .,'- aipacity.------- -------_-_-------90 <br /> ❑ Size: Diameter------------1--, <br /> --------------------------Depth---------­-------- ------------ -----------------Liquid C <br /> Privy_ Distance 'Distance from nearest building.----------.-I---------�t---------------- <br /> ce from nearest well----------------------------------- -- ---------& <br /> Distance �o nearest ]of line----- -- -------- ...... ...................................------------------ <br /> 0 <br /> ........... <br /> e in, ------- <br /> Remod I g'-a_n"d/ 11 cr,ib-0 P <br /> ........ ...... <br /> --- -------- <br /> ---------- . ...... <br /> --------- ----------- 7_13.-I-A--------- <br /> - ------------- <br /> ..................... <br /> - ----------- --- <br /> 7� --------------------- --- <br /> ----------- - --------------------------I----------------------------------T--------------------------------------- ------ -------------------------------------- <br /> _k v I h`ere'b certify that I have prepared this application and that the work will be done in accordance with S" <br /> �� !Joaquin C <br /> ordinances, Late laws, and rules and regulations of the San Joaquin Local Health District., <br /> -tz - <br /> - -----------------------------------------------------------------------(Owner and/or Contractor <br /> ------ <br /> ------------------------------------------------(rifle)----------------------------- ------ ...... .... ..------------ <br /> --------------- <br /> By:-------------------- ------------------ <br /> (Plot plan, showing size of let, location of sy'#em in relation to wells, buildings, etc., can be placed on reverse side). <br /> J <br /> FO DEPART ENT USE ONLY <br /> ------------------------ DATE------ - --------------------........ <br /> • <br /> APPLICATION ACCEPTED BY--- --- --- -- -- ------ ---- ------------------ <br /> ------------- DATE ............. ----------- ----­--------------­�------ <br /> REVIEWEDBY-----------------•---------------------------- -- ------------------------------------- ----------------------- <br /> -_---------------- <br /> -------------- DATE. <br /> PERMITISSUED------------------------- -----------------------­-----­----------- <br /> Alterations and/or recommendations:--------------- ------------- --- ---------------------------------- <br /> ----- ---------------------------------- <br /> - I - .......... <br /> ------------------------1---,4—-------I/-------------------- ------------- <br /> ------------------- --------------------- <br /> -------------- ------ ------------ -------- <br /> ---------- <br /> Lx, ------------ <br /> -------------------- ....... - -------- ..............V--/ ---------------- <br /> .....C-L ------�0_-- <br /> ----------- --------------- <br /> P <br /> FINAL INSPECTION BY: <br /> Date_------------- --------------------------------- ----------------- --------- <br /> ---------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak street 124 Sycamore Street 205 We$ 91h Street <br /> CaliforniaStockton,California Lodi,California Manteca,California Tracy, <br /> E9 9 REVISED B-69 2M 5-61 ATLAS <br />