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E - --------- ------- -------- ------------- -------------- APPLICATION FOR SANITATION PERMIT Permit No ------------------------------- ---------------------- ----------- This Permit, -xpiresLI Year From Datelssued Date Issued ------- -- ------------- ------- -------- (Complete in Duplicate) Applica, t ;on is here6 "' -%,j This application is m" e 10 the ban Joaquin Local Health District for a permit to construct and install the work herein described acle in compliance with -County Ordinance No. 549, JOB ADDRESS AND LOCA :U5�61 ZTN__7Z31:y._ Owner's Name --------- ------------ ----------------------------- ------------ -------------- ---------- :_ - ---------------- -------- ------- --------------- --- Address ------------------- -- --------- ----- ------ Phone -------- ---------- n!7 --------------- .. ......... eT� -------------- ---------- Contractor's Name__.____4 -- - ----- .............. ........... K� ----- --------------------- ------ --------------- Installation will se' t j -------- ------- Phone -_--------------------- rve: Residence 22 --'Apartment Hobse'[D Commercial El Trailer Court Ei Motel ----------- Numbdof living units'bedrooms`„ I i 0 Other E] Number'of bedro 1 S"12. Number'of 1aths e om Wafer Supply: Publics Lot'�iz c sYstemA 2" Community sYsf6m El \Private --------------------- --------- Depth �o Wafer Table Character of soil to a depth of 3 feet: Sand E] G're"v cL \ ' ' ' el ❑Sandy Loaml Lo. El Clay m i Clay [I Adobe (Hardpan Previous Application Made:, (.If yes, date--,, ................ ;No New Consfruction: Yes ❑ Nd'R FHA/VA: Yes ED Na - 11. _. -, 1, -, _1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank ' or cesspool permitted if public sew:er� isavailablewithin 200 feet.) Septic Tank- Distance from nearest 'wejj V , �_ 1- I. '6'm foundafio'. ------- Distance from foundation _..= of compartments ----- 4o4 --- ------------ Size ................. . " / ! , .&� .1 ------------ Capacity -Ree ---------- -------- Liquid depth ---- 0 Disposal Field: Distance from nearest' :D istance from f&nclaticin-1 --- Xyr Number of lines �141 __-__-__Distance to nearest lot line -47"' -------- ----- � ---- ;?I ------- - -Length of e' " 'N Type of fiJfer ma!erial-/ ach l'nP-0-7!-?k�_' -.Width of french.&Z-- of 'Mt, '11"4- rw r mat'e'rfe!_' _�v 7_1 ----- ! --- Total lengfh__,� Yj Seepage Pit, Distance to nearest wel -------- I ------ — ------------ Distance 6m* Tf"undatio'n'_ Number of pits__:__-. ... ..Distance to nearest lot line --./ ------------ Lining maferial--., i; -Diameter',, ----- Depth--...? ------ el-.. ----------- Distance from e �- Cesspool: Distanctj from nearest weil ----------------- foundaf;on ----- ---------- �fLining �materiaf -------- El Size: Diameter-------- ------- ir --- - ------------------- epfh ----- ------------------------------ ---------------------------- Liquid Capacity Privy- Distance from nearest well ------------- gals. -------- Disfance from nearest buildin" Fl -Distance to nearest lot lin'e - - ------------------ �`-- -------------- -------------------------------- g-- -- ------------ ------------------------------------------------ Remodeling ancl/or-re-Fgi--jng piFc-ri ------------------------- ----------- - ---------- ----------------------- ------------ I ----------------- A --- - ------ I ---------------------------- I ---------- --------- ---- ----- - --------- �f ---------- ------- ---------- ----------------- ------------------- - -------------- ---------------------------- -------------- -------- --------------------------------------- -- I I ------ - --------------------------------------------------------------------- I , hereby certify that I have prepared this application and,fhaf the work will be don6 in accordance with San Joaquin County E ordin,ances, State laws 'and rules and regulations of the San Joaquin Local Health District. (Signed).... ---------------- ---------- By--------------- - - (Owner and/or Contractor) - (Plot plan, showing size -of lot'llocafion stem --- ------- _,(Tiffs)--- dAlor-c- �___ ----------- ------ ............. etc., can be placed on reverse side). )R DEPARTMENT USE ONLY APPLICATION ACCEPTED' BY_ --- REVIEWED BY --------- ------------------ ! ------------------------- DATE_ JO._."`" ............. ----------- r---- ------------------------------------- ---------------------------- -- ----------------------- -------DATE------------------------ ....... BUILDING PERMIT ISSUED DATE__ -------- ----------------------- Alterations and or recon -------------------------------- DATE ---------------- ------------------------ end ions:, -----------== ---------------------- ------------ -- __Z ......... . .... ..... - ----- ------------------- ------------------------------------------------------------------------------ ------------------- - ------ ------ ------ I -------- I -------- ,A__L�_ ----------------- -------- -------- 11 ------------------------------------------------------------------- ---------------- --------- ------- - --------------------------------- ----------------------- I -------- FINAL INSPECTION BY:_( -I 130 Y:_(7- 130 South American Street Stockton, California TS.9 REVISED 8,59 F^ao, 2M 15.60 ----------------------------------------- ---- -------------------- ---------------- -------- ------- I ------- -------------------------------------- -------------------------------- i�t� ---------------------------------------------------------- ---------------------------- ------------------------ ea - D ----- —0 -------- ate -----/P- C --- ------------- ------- ------------ --------------- SAN JOA Q L HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street Lodi, Calif��i.t A 205 West 9th Street antec,,\Ccirlfornja Tracy, California