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FOR OFNIE-E UKST: <br /> --------------- <br /> ----------­--------- Permit No. <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------- ------ ------------------ ---------------- <br /> A -------- JS <br /> -------------------------- <br /> (Complete in Duplicate) Date Issued e _411-101 � <br /> ------ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> J Z <br /> JOB ADDRESS AND LOCATION------ --------- --------_-- -------------------------------------------------- <br /> Owner's Name__ ----- ------------------------------------------- Phone------------------------------------ <br /> VZ-AT{-- ............................................... <br /> ----------- -------F------------------ <br /> Address---------------- --—-------/ --------- <br /> V4A ----------------------------------------- Phone---------------------------------- <br /> Contractor's Name----------- ------ ------- --------- Motel El Other <br /> Installation will serve: Residence ®' []r- ApartmentiHouse ❑ Commercial Ej Trailer Court El <br /> ❑ <br /> I Lot size -------/-----)9_073- <br /> Number of living units: -1---- Number of be'dro'oms 2—.- Number of baths __/--- <br /> Water Supply: Public system ®/'Community syst4n [] Private Ej Depth to Water Table ft. Hardpan <br /> Character of soil to a depth of 3 feet: Sand ErGravel'-E] Sandy Loam Clay Loam,-E] Cloy E] Adobe E] <br /> ❑ <br /> Imt 4 so;- V <br /> ion: ']:! <br /> Previous Application Made: (if yes,date___.__ es L2 FHA/VA: Yes 0_- NO 9 A, <br /> 7 TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool.permitted if p4blic sewer is available.within 200 feet.) <br /> ---- <br /> Septic Tank: Distance from nearest well----41t� lal----R E r_>-L-A)0 Q> <br /> -(&Distance from foundation _./0----------Mater* ------- <br /> Ca <br /> No. of compartments_____ -1----- Size---3-')(-'?---X---:;O---'Liqu*d depth-- -- ----------- pacity---- <br /> well__C_W---Distance from founclation.--1.0---------Distance to nearest lot line--, <br /> Disposal Field: )f Distance from nearest --------3_6- I- --------;0.... <br /> • Number of lines------�7�n------- Length of each line------- -----Width of trench. CZ:I <br /> E�l ----- "!7--- -----Total length--------------------1­0----�—----------- <br /> QCAI� 47- <br /> Type of filter material-__R I ---Depth of filter material 0. <br /> Seepage Pit: .1 Distance to nearest well -_--Distance--- -------------------Distance to nearest lot line--._. __. <br /> --------Distance from foundation 4W <br /> Nu'mber of pits----- Lining material--___ ---Size: Diameter-.---- ----------Depth----_--------------------------- 0 <br /> F1 f, ----------- <br /> Cesspool: Di�'tance from nearest A------------- ......Distance from foundation.-------------------Lining material__----------------------------------- <br /> -----gals.❑ 4A <br /> Size: Diameter.__.--- ----Depth----------------------------------------------------Liquid Capacity----------------------- <br /> Privy: Distance from nearest well--u------------------ ------I-----------.-Distance from nearest building_____ <br /> F] Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------------------------------- ------- <br /> Remodeling and/or repairing (describe :------- <br /> (describe :I------------i-------- ------------------------------I ----------------I-------------------------------------------------------------------------------------- <br /> 0 <br /> I— ---------- --- -------- - -- - <br /> ---- --- - <br /> ---------------------------------------- -- -- ----- - - ---- - -- <br /> -------- --- -- - <br /> ---- <br /> -------- ------------------- - j------ ---- ---------- -- <br /> -------------------------!t�4�--- <br /> n� --------!!n:----------------------------------------- ----------------------- <br /> ---------------------------------------------------------- I k - . �� _... I will be done in accordance with San Joaquin County <br /> I hereby certify that I have prepared this application ands the work v <br /> ordinances, Stajo-t d regulations of the San-'Joaquin' l2'ocal,,Heta`Ith District. <br /> ,aws, and ir�qs an I . I------ _(Owner,an (�on tractor <br /> ----------- ----------- ------------- /2r- <br /> .�(Signed):f7!�------- ------- <br /> ------- ---------------------------------------------(Title)---------- --------------------------- ---------------- <br /> By:----------------------------------------------------------I f <br /> (Plot plan, showing size of lot, location of system in re allion to well , buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- ----------I------------------------------------------ --- ----- DATE-A ------ <br /> REVIEWED BY---------------------------------------------- ------------- ------------------------ --------------------------------- <br /> DATE------ ----------------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------I--------- --------------------------------------------- ------------------------------------- DATE.--------------------------------------- -------------------- <br /> Alterations and/or recommendations:----------------------------- ---------- -------------:----------------------------------------------------------------------------------------------------- <br /> -.@— -------------------_------------------------ <br /> ------------------- ----------- ----------- -------------------------------------------------- <br /> ------------------------------------------------------ <br /> ---------------------------- <br /> �,V t7A %Sx ---- <br /> ----------------------- ------------------------ ----------- -------- ------------- -; I. . C 1� -------------__------------------------------------------------------- <br /> ---------------------------------- ----------- -- ---------- ---- - ------------ - -- ----- ----------------------------------------- <br /> ----------------- ---------------- -------­_­_�_�---- --- ---- - -------------- -- -----------------------------------I------- --------------- ----------------------------- ---------------------- <br /> Date---- -------1 ---------- -------------------- <br /> FINAL INSPECT ..... .. . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.1213. <br />