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FOR OFFICE USE: <br />---------------- ------------- ---------L------ <br /> APPLICATION FOR SANITATION 'PERMIT Permit No. <br /> ----------- --- -------------- ........ ------ <br />--- ----------­- ----­------------------ ------- (Complete-in Duplicate) 13 Date Issueg/--- <br /> ------------------ ---- This Permit Expires 1 tio <br /> ar Frm Date Issued <br /> Application is hereby made to the San Joaquin Local Health Disct fora permit to construct and install the work herein described. <br /> t 1 4. <br /> —This.,applica ion.is made in-compliance with County Ordinance No 549. <br /> d-------.1 6,416dZ6"(4----- ----------- <br /> JOB ADDRESS AND LOCATION_--- &t�------- 9,115 - �Z <br /> -------- Phone. <br /> Owner's Name----- ,5- ,v-7 7------- � <br /> )9_­�� ­­­ ----------------------------------------------------------------------------------------------- <br /> Address-----------------/)/.-6---V�_e---i;m;�-Z=0�7-- 7;0; �t - <br /> Contractor's Name------ ------- ------- V TnA -- ---------------------------------- Phone----- ---_---------------------- <br /> ercial Motel E] Other C3 <br /> Installation will serve: Residen�ceR'._Aparfment House ConC ei�,)ailer Court <br /> y -ter <br /> Number of living units: ./.... Number of bedrooms a-- Number of baths--------- Lot size ---- ---------------- <br /> Water Supply: Public system E] Community system)e Private F-1 Depth to Water Table ------ - ft <br /> Character of soil to a depth of 3 feet- Sand 9 Gravel F] Sandy Loam [] Clay Loam [I Clay [1 Adobe 0 Hardpan E] <br /> Previous Application Made: (If yes,date-----.-. _....... ) No JK New Construction: Yes No E] FHA/VA: Yes F1 No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> No eptic fank.o�r.cesspool permitted if public sewer is available within.200 feet.) <br /> Septic:Tank: Distance from nearest well---!=------Distance from founc1afion_/_-0__..------.Material RF�1! 7)---2Z_;CjW <br /> ----- <br /> No. of compartments- --------- -------- .--Size------_------------ ----__---Liquid depth--------- ------- ------ Capacity ---------- <br /> Disposal Field: Distance from nearest well .1 K5- <br /> Distance from foundation---/,!�Z......D�6tance to nearest lot line--- ------ <br /> --------------- <br /> Number of lines_...-.--®4----------------------Length of each line----..1416qtO�15 <br /> �OWidfh of trench <br /> Type of filter mate r lal_,okx)a/C------- --Depth of filter material___3--------------.-Total length.../(p.-d---------------- -- :wl <br /> Seepage Pit: Distance to nearest well------___..........Distance from foundation------------------- Distance to.nearest lot line....---_......... <br /> El Number of pits--- ------------------Lining material...................... Size: Diameter.----------------------m....... ---Dept k--. ------ ------m_------------ <br /> Cesspool: Distance fi-om nearest well ................Distance from foundat�on--------- ------- --Lining material--......M------------------------1__.. <br /> Size: Diameter_ .-- - --- ----- __ ......----Depth--------- ------------------------ - -I----------...Liquid Capacity-.--------------------------v.gals. <br /> 4. <br /> ----- ------------..Distance from nearest building............._.-..-..--.------M__-------. <br /> Privy: Distance from nearest well_........___....._....___.. <br /> 0 Distance to nearest lot line-------- - -------------_-__------------------M1------------------M-----------------------------------------------M-M---- - ------------ <br /> -------------------------------------- <br /> Remodeling and/or repairing (describe):'_,,A .-<----------------- ----------I-------------------------------- --- ----I------------------- <br /> ii <br /> ---•--------•-------------------------------------------- ----------------------------------------------------------M-----------------------------­---------------M--------------------------------------------------------- ? <br /> ------------ ------------------- ---------------------------------------------------------------------- ----------------------------------------------------I---- ----------------------------------------------------- <br /> f.--------------M--------------------------------------------- ------ ----------------------- ------------------------M------ <br /> ----------------M ------------------------------ <br /> I hereby certify that I have prepared this appI <br /> J;eafion and that the work will be done in accordance with San Joaquin County <br /> 'on <br /> ordinancr.-11�3 laws, and rule d regulation oft n Joaquin Local Health District. <br /> -----------------M------ ------------------- - --------- and/or Contractor) <br /> [Signed)------.. -- ----- -placed-on-reverse-side)�­ <br /> _ -wells,-buildings; <br /> �.�in-f -wLells---6uildings,-efc�,-can�6e <br /> By:-------------------------------- ----------- ------------------ ------- -M------ -------------------------------------[Title)--------- - -- <br /> -[Plot-plan; <br /> ---- -—(Plot-plan-rshowing-size-of-lot,—locafion-of-system 2in-relati <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED - --- ------ DATE_ ------------ <br /> REVIEWEDBY----- -------m-- -------------- ------ -------------- ----------------------------------- -- ---------- --- ----------- DATE------ ----_--------------•------__--------------------- <br /> BUILDINGPERMIT ISSUED-------- -- --------------------------__----------M_-------------------------------------------- DATE--------- ------------------------- --------- --------------- <br /> Alterations and/or recommendations:-------------- -- ------------- ........ --- -----------------------------------------------------------------------------------------M----------------- <br /> --------------------------------M------- ----------- ------------------------ --------------------- --------------------------­----- ---------------- -------------------------------------- ---------­M-------- <br /> -----------------I-------------------•------------------ ...-------- ------------------------------------ ----------------- ------------------------------------ ----- --------- --------------------------------------- <br /> -------------------- ------- ............ .... ------------------------ - ----------------­ ------------------------------------------------- --------------------------------------- <br /> FINAL INSPECTIC) BDate--.. <br /> - -------------------- <br /> - ------------ ------------­-- ------------ ....... ------------------------- ---------------- ----------------------- <br /> :� Date... --------------------------- ------- -------- <br /> S JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> stocktoo,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />