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FOR OFFICE USE: <br /> - -- --------------- all---- <br /> 33 <br /> - <br /> Permit No. -------- <br /> APPLICATION FOR SANITATION PERMIT <br /> --- ------------- <br /> -------------- in Duplicate) _-Z V—4 <br /> (Complete .'., .Date Issued -------- <br /> ----------- This Permit Expires I Year From Date lisued <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 Coulit Ordinance No. 549. <br /> I <br /> 11 T --------- <br /> JOB ADDRESS AND LOCATION---- <br /> ---------- - <br /> --- - - <br /> Phone------------------------------------ <br /> Owner's Name--------&I - ----- <br /> ­C_x- - -- ------------------- ------------- ----------------- <br /> Address--------- .... ...A.. - <br /> 1� -s-i� --- ---------------- P h o n a. 11 2_ g <br /> Contractor's m ------- <br /> Motel [3 Other <br /> ,serve' . Residence <br /> Installation wix1I1 !:!K Apartment House [] Commercial E] Trailer Court El ❑ <br /> Number of living units- /---- Number of bedrooms __.7._ Number of baths --2-- Lot size -.-, �' �J�.-- _7--- <br /> Wafer Supply: Public system ----------------- <br /> Community system El Private F-l Depth to Water Table/sft <br /> A <br /> Character of soil to a depth of 3 feet- Sand E] Gravel El Sandy Loam [] Clay Loam C9' Clay El Adobe 0 Hardpan 0 <br /> Previous Application Made: (I;f Yes,date------ ---------.- ) NOIX New Construction: Yes& No [:1 FHA/VA: Yes Ej No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> p <br /> Distance i?onri nearest welL.-S-0....Distance from foundation---/0�---------mafer -----c4li <br /> Septic Tank: ------------- <br /> NA No. of compartments." --1.7---------------Si"l-b-k 12-----Liquid clep�k---41----- ------- Capacity,/.1 (7.�� <br /> Disposal Field: Distance from nearest well -"'.-Distance from foundation--- ------..Distance to nearest lot le--d"."-------- <br /> Number of lines ch------ 01 <br /> of each line__._ V---------------Width of trench.--.-.r - <br /> Type <br /> ------ - -------------------- <br /> ----49 ----- Total length <br /> Type of filter material-" - ----- - --------Depth of filter material <br /> Seepage Pit: Distance to nearest well-------___---------_-Distance from foundation------_------------Distance to nearest lot line--.----.-------.- <br /> s <br /> ❑ <br /> ine----------------- <br /> 171 Number of pits_ --------Lining material---------------------- Size: Diameter--.--------------------Depth--.-----------------------------_ <br /> Cesspool: <br /> epth--------------------------------- <br /> Cesspool: Distance from nearest well ---------.".....Distance from foundation--- ------------- Lining material----------.----"---.-.-------_---.-.. <br /> ❑ <br /> aterial----- --- --------------------- <br /> EJ Size: Diameter- -- --------- - --- ------- -------Depth------------ ----------- - -- -------------------- Liquid Capacity-...-.-.-------------- ---.gals. <br /> Privy: Distance from. nearest well--- ---- ------- -------- - - ----------------- -Distance from nearest building"---.-_----------.-------_------._" :� - <br /> ❑ <br /> uildinq- - -------------------------------El Distance to nearest lot line.............. - ----------------­------------ --------------------- ---------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):------------------ -- - --------------- --------------------------------------------------------------------------------------------------------------- <br /> --------­­---------------1--------------------------------------------------------------------------------------------------------- --------------------------------I------------------------------- -------------____ - <br /> --------------------------------------------------------------------------- <br /> - ------------------------------------------------------------- ------------------------------------------------------------------------ ------------- <br /> N. ---- <br /> ------------------------------------------------------------------------------------------------------------------------- <br /> -------- -------------:------------ ---------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and reclula-tions of the San Joaquin Local Health District. <br /> (Signed],-------------- _e� ------------------- --- -------------- - ------ --------------(owner and/or Contractor <br /> BY=-----------Lr t-------- -- ----- -------- <br /> ------------- ----------------- - <br /> ....... ----------- -------- ------------ (Title) <br /> -- -- ------- -- - <br /> (Plot plan, showing size of lo?t, Ioc ion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> F011, R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ----- DATE------S7a ... <br /> . .. &-------- --------------- <br /> J <br /> REVIEWEDBY-------------------------- -- ------ ------------------------ - - ------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED----- -------------------------------------------------- <br /> / <br /> SSUED------------------------------------- ----------------------------- ---------------- --------- DATE----------------- ---- - ---------------------- ----------- - <br /> Alfecations, and,/o Xreco�mnmendaffions, ------------------------------------ ------- ----------------------- ------ --------------------- - <br /> a <br /> --- ------ - -------- <br /> -------------- --------------------------------_------------------------------------------- <br /> - -- ----- ---- - --------1------------------- <br /> 0 -------- ---- ----- --- -----/----------------------------------------- ----------- --••------------ ----- ------------------------------------- <br /> ...... ....-1. ........ --------------------------------- ----------------------- -------- -- -------------------------- - <br /> -- <br /> 4 -- --- -------------- ------ ---------- - - ------------------ --- - -------------------- - ----------------------------- <br /> - -- <br /> -- -- -----I........ ------------------------------ <br /> FINAL iNSPECTION BY:. XV-5......_ Date. <br /> ------------------------ - -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> I <br /> Stockton,California <br /> Lodi. California Manteca,California Tracy,California <br /> to <br /> E.H.9 2M 1-67 Vanguard Press <br />