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FL.•-,.,jrriCE USE: --------------- Permit No. ..... L.?.� '.1 ------------------------"-" "-�---�- APPLICATION FOR SANITATION PERMIT -- ---------- -------- Com le#e in Duplicate) l --------------------------- . ] P p� ] ba#e Issued .-L --��1_C.- _ ._ :"""._'_.~-�_T.._._ This Permit Expires 1 Year From Date Issued :�'0.��. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work ,h{e�rein described. This application is made in compliance with County Ordinance No. 549. Z_Z3 -74) OS Tom . F.. JOBaADD,RSS,AND LOCA ION------- A - Fl_h5 1. Phone---------------- ------------------ Owner's�;Name ��-----�-�•--- ---�---- --- Address:� �•=_= _J_C � r-TT_ _�T_�=:---------•----- I - ----------------------- I , 4 one------------------•---------------- Contractor s Name__0I�1'�,I_T�=� _--�- �T! 1 _1� - Motel Other Installation will serveResidence 1�Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ ❑ f ............ Q------------------------ Number of livi g ni1ts __�_____ Number of bedroomsNumber of baths f:-__ Lot size ___-, _ x �^. Water ISppply: Public system Community system ❑ Privat e bepfih to Water Table ti - y Adobe Hardpan ❑ Character of soil to'a depth of'3 feet: Sand [Gravel [] Sandy Loam ❑ 'Clay.Loam ❑ Clay ❑ ❑ Previous Applica+ion Made: (If ye;d e_____ No ] New Construction: YesiiT�� FHA/VA: Yes ❑ No 0— TYPE OF INSTALLATION AND SPECIFICATIONS: --(No-septic tank--or-.caess cesspool- ermined if' ublic sewer.is•available-within�2iJp•�feefi } 1 # P p R� Q-- --- Mr rial__-11-E�b 0 f? _. �J , Septic j ank: Distance from nearest well._--- ' -r---Distance from folndation _ Capacity ' No. of compar#mem _s----- '� Size_ -Y-= -)C ------Liquid dac epth__`' ---.- P Y• -- - LW' • / Disposal.Field: Distance from nearest li.... .._U :Distance from foundat;on_._:I --------Distance to nearest lot lin` --------.-- �_ 24 Number ¢Irnes__.-- --i- DeRgfih of each line:--•--- -�-- -----Width of trench-----:2- ---------------------- 0 Le P thof filfe' material . �l Total,length------------------------------------------ T e oftfilter mateiia PgYP , l w _Dista ce-'f-rom foundation___________________Distance to nearest lot line__. ___________. 0 Seae Pit: D st. nce to nearest well _ ___ _. r' Size Diameter Depth --Linin material_-- -- -- -------- Number f its_ - g .� � Cessool: Distan e fi m-.nearest well_________ --'FDis ante from,foundation__ "._.. "---------L;ning material.--,: _________ ____ p '" ,`� Li u id Ca acit -----------------Depth----------------- q . P Y gals Size: Diamet r----------- ------ - -"� _--____________- _Distance from nearest buildin f Distance-+om nearest well------------------------------------ _ - -----------------------------•-------- --------- 4 ❑ '^ i Distance to neares"t 16t.line - - Remodeling and/or repairing`(doscribe):_ _ l_T _.__ � lu ---- , 131A-1-4- 1 "c4--- i-r�i -.- ---- ----------------------- - = " -------- -------------------------------------------- •- ``==_:-------- = hereby ter ify that I have prepared +his application and that the work will be:done.in accordance with San Joaquin County ord;narices, State law';.and-rules an regulations of the S n Joaquin Local Health District. r`s ner and/or Contractor(Ow / ] (Signed] --------------------------- By ------------------------------- --- ----- - [T;tl -V17T, (Plot plan, showing size of lot, location of system in rela+ion to wells, buildings, a+c., can be placed on reverse side] E FOR DEPARTMENT USE ONLY �. DATE-------=�-25...x`-�- -------- i APPLICATION `ACCEPTED BY ---- f r �r_ ------ -- --"-------- --- ----- ------------------ -- -- - - - . - - . -"-* 'DATE ----------------- REVIEWED BY -------------- ,� .��--- b '�-- --------------- Vk i DATE-- --------------------------------- ------------'- - BUILDING PERMIT ISSUED----------------- -------------------------------_------ C Alterations and/or recommendations:------- ---------------------------------------------------------------------- ---------•---•-•-•--_-- --------------------------------------------------------------------------------------------------------•----.-----__...------------ ----------- ----------- - --------------------- -------------------------------------------- --------------------------<<;r-•--------.---------•----------------•- ------ I ---------------•- -i ----- ------------ ----- -- --- ~:. Date----------- { -Y----------- -- - FINAL NSPEC N BY- -- -------- ---• r -SAN JOAQUIN LOCAL HEALTH DISTRICT A 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Mantecar California Tracy,California Stockton,California � �� FS 9 RCVISEO 8.59 3M 3-'63 F.P.CC"