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FOR OFFICE USE: <br /> .......................... ;2- L <br /> APPUCATION FOR SANITATION PERMIT Permit No. ------------ <br /> .......................... .•-•--•--••--•----.----- (Complete in Duplicate} <br /> ................................................... This Permit Expires I Year From Date Issued Date Issued <br /> ^pplicafiGn 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 macie-in compliance with County Ordinance No. 549. All <br /> ............................. ............ <br /> JOB ADDRESS AN90,,�OCATION_­6Z <br /> ------------ ....--••--,. Phone. <br /> ------- _........................ <br /> Owners blame.--•- ...• <br /> ....... <br /> Address................... ------•----------•- <br /> ---------------­--­-------------- <br /> ............. ....... <br /> Phonesf <br /> Contractors Narns:_ ........ <br /> her El <br /> Installation will serve: Residence gr.4: artmenfj�.ouse Commercial F1 railer Court 171 Motel 0 <br /> Number of living units: Number of bedrooms Z... Number of ths _Z�-. Lot size .- . .......................---_---------- <br /> Water Supply: Public system 0 Community system E] Private of <br /> to Wafer Table6a_ ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam 0 Clay Loam [3 Clay [] Adobe J24'ardpan El <br /> Previous Application Made: (If yes, NO ,[] New Construction: Yes Ej N&4k—FHA./VA_- Yes.0 No C] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS.- . ._-; <br /> (No septic tank or cesspool permitted if public sewer is availabwithin' 200 feet.) <br /> See , : D-,stance from nearest well...................Distance from foundation._..._.............Mate eral..._...._....__.-..W-.__-_-.__...__...--___.. <br /> No. or compartments-_--.....................Size._-...............�j:.._....Liquid Capacity-------------- <br /> "rest well. foundation- Distance to nearest lot line..:�_.­... <br /> a field: Distance-from no _7_e_._J0istance from iou'rtclatio <br /> Length of ne -----------Width of french Number of lines.-,,1 each li ;f------- <br /> Type of f1l4er mt Depth of filter I Iter Ma4,ial--- __.../_._._.;offal length-----.-- -1 - ------ <br /> or <br /> Seep e Flit: stance to nearest well_/j�v_­ _Distant r0q, fbunc1ation.../19'_._._.Distance to <br /> r <br /> neares tot <br /> Depth....... ?_X. .............. <br /> Number of pits,_L.-------------Li;ing materiaL X94 Size: Diameter-_.-_ 5--- <br /> Cesspool: Distance from nearest well......_.._..-_-Distance from foundation-.-.............Lining material......_---_-_ ------ <br /> 17 Size; Diameter.........._..:,..... r .-•---...Depth.----•--•-. ..................0.--.............Liquid Capacity......__--------- <br /> Privy: <br /> istance trom nearest, ........................Distance from nearest building_--------------_------------------ <br /> r7lDistance to nearest lot Lina....,,.....,„..__,....._....---•------------------- ._..--•-•-...................Tf..... <br /> Remodeling and/or rapair.-ng ....... .......... - ---------- - --------- ....... ---------- <br /> ..........­........... <br /> .......... ——------­------- <br /> .......................:...... <br /> ..................... <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'llid.-rules and regulations. of the San Joaquin Local Health District. <br /> (Slqna�d)_ %4...1.C:.9: ...... -------------- <br /> Y2KJ54_Min".AV8.' -------*...... <br /> ikF"*n0 TANK SERV <br /> B al..._._I. ..........1-1-r-------­--­--- ..A_ ------------Artle)----------_---------- ----- - ------ <br /> - <br /> (Plot plan, showing size of lot, location of system in relationve Gil$, buodinV, etc., can be placed on reverse side). <br /> A FOR MPAKTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> DATE-_ <br /> ATF--.-. .-- -_--------- ---- <br /> REVIEWEDBY..........................--- .... ......... .......... DATF. .. . ................. <br /> BUILDINGPERMIT ISSUED......__---------- .--•------...__...............--_..._..•--------. DATE.....----------------------- <br /> Alterations and/or reclom I mailcWtorls:...........#._­.. ...... <br /> dt, . ...........:­��...... <br /> ......................... <br /> ........... -- -------------------- <br /> ........... ............................................................... .................. ......... <br /> .............. ..... --------- <br /> FINAL INSPECTION ...... Date.........-4-------/._Zr :_!� .............. <br /> PSA J QUIN LOCAL HEALTH DISTRICT <br /> 1601 1.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,CaliforniaLodi,California Manteca,California Tracy,California <br />