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APPLICATION FOR SANITATION PERMIT ete in- p;Mj1Duplicate) Date lssivcl__:,!h--A Applica+ion is hereby made toithe San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in copliance with County Oi;oiriance No. 549. 0 -------------------- -------------------------------- -- ---- Phon_____ JOB ADDRESS AND LOCATION---- Owner's Name----------------------sz�.•-- _2............2.2 .... Address---------------------------------------11.............. ------------- ----------- P7 --------------------------- -----------------------------------------------Phone.. - Contractor's P_-h-,o,_n--------------------------- Contractor's Name________________---I-------------------------------4—-0--- - -------------- - il.: Motel El Other Installation will serve: Residence [Apartment House ❑ Commercial E] Trailer Court [I 2 ❑ --- Lot size S-7- ----------------- Number of living units:: I--- Number of bedrooms -Y-. Number of baths - --- ---- Water Supply: Public systemll 21-1c"Ornmunify system F1 Private I—] Depth to Water Table i7vft. P. e Rarclpan 0 Character of soil to a depth d 3 feet: Sand Gravel [] Sandy Loam El Clay Loam [I Clay ❑ Adobe Previous Application Made:.. es E] No Now Construction: Yes [] No E] 0 U TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesJool permitted if public sewer is available within 200 feet.) S tic Ta Distance from nearest well________________Distance from Jm' foundation--------------------Material------------------------------------------------- ------------------Size__...:----------------- No. of partments--------------------------Si' ---------Liquid depth----------------- ------- Capacity----------------------- D apacity----------------------- D nearest well-- --------------;.Distance from foundation------------------- Distance to nearest lot line--------------- (�Zal Relo: Distance from ne I �r lines-----------------------------------Leingth of each line_. Width of french----------------------------------- Number 0''T r Type 07 filter material-------------------------Depth of filter material------ le--------Total length-------.---------------------------------- 4 ------------ Seepage Pit: Disita"nce to nearest well-111in --------Dista f foundation-1-0-------------Distance to nearest lot line 9L _____Distance Trqm Number of pits.--I------------------Lining material--u-&C4----Size-. Diameter---- .......... 111 m, nearest well-----------------Distance from foundation_-_-_...__..____-__.Lining_... Cessp,001. Distance. ------------Lining material------------------------------------ : 110 Diameter---------r----------------- ------------Depth- ----------------------Liquid Capacity----------------------------gals. El Size. Distance from nearest building--------------------•-------------------- Y uilding------------------------------------------ m 1� Privy.' Distance7lrom nearest well--------------------------------- - --Distance io nearest lot line---------- ------------------------------------------------------•------------------ ----------------------------------------------------------- Remodeling and/or repairing (describe):___--------------------------------------------------------------------------------------------------- ---------------------•------------•-------------2-------------------------------------------------------- -----------------------1------------I---------it------------_--;- ---------------------------------- -------------------- ---------------------------------------------------------------- HO --------------------------------------------------------------------------------------I-------- - ---------------- -------------------------------------------------------------------------------------------------------------------------- --------------------- ------------------------------------- I n I hereby cert at-I �,_ve prepared this application and that the work will be done in accordance with San Joaquin County t "- - I flons of the San Joaquin Local Health District. ordinances, State aw and rules an �e Lulat & i_ Contr actor) (Signed ---------- i---- - ---- --------------------------------- -------(Tiflell---- �-nxq'o........................... --- -----------------------------------*------------ ---------------- ..... . ... ...................I---------- -------------------------------------- By:. to wells, building plan, showing size'of IJ�, location of system in relaf.io uil ing etc., can be placed on reverse side). Jl: FOR DEPARTMENT USE ONLY DATE--- ---------------- ----------------- ---------------- APPLICATION ACCEPTED 11By----------------------- - --- ---------------------------------------------------------- "------ REVIEWED BY------ -------------------------•--------------------- _ - DATE--------- ------ -- ------------------ ---------------- ------ ------------ -. DATE---- if------ k --.-_ -1- --------------- - BUILDING PERMIT ISSUEDA:------------ -------- ----------- ---- ------- --------------------- -- ----------- ------- ------------------------------------ -------- Alterations and/or recommendations-------------------- ------- -------------- ---------------------------- .11' ----------------------------------------------------------------- ---------------------------------------------------------------------------------- ------------------------------------------- --------- --------------------------------------------------------- ----- -------------- ------------- ---------------------------------------------------------------------------------------------------------- -------------------------- --------- ----- ------------------------------------------ ------------------------------------------ ....... -------------------------------------------------------------------------- ----------- --------------- -------------------- ------------- ---------------- --------------------------------------------------------- ------------------------- -----------------I-------------------- ---------------------------------------- Date------- ---------i ------ FINAL ----FINAL INSPECTION BY:------------- .... ----------------------------------I-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street ill Sycamore 11ree, 1114 N.4 "C" Street TracCalifornia Stockton, California f Lodi, California Manteca, California y, _,,ES_9_2M ; , Revised W-2100