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FOR OFFICE USE: <br /> L.. <br /> Permit No. ...!..7.�. .`f..... <br /> to .___..._. ... .. .. ---- <br /> APPLICATION FOR SANITATION PER <br /> (Complete to Duplicate} Date Issued _-r1"--- <br /> ..--- """" ••... .. .• This Permit Expires.i Year from Date Issued <br /> -- 1 <br /> ' Application is hereby made to the Son JoaquinLocal <br /> Health <br /> cDtNoc 549,a permit to construct and install the work herein descrl e ` <br /> I This application is made in compliance with y <br /> LOC T ION.. n ��. <br /> I JOB ADDRESSPhone_ <br /> �.... <br /> Ca----- <br /> .. <br /> Owner s <br /> Name. <br /> !�.(.t'`r' '�'-. , •��.- - �✓'! <br /> _ . ..� <br /> ✓jay ,o� <br /> � <br /> I Contractor's Name; `�-- <br /> Motel Other <br /> ertment House ❑ Commercial ❑ Trailer Court ❑ <br /> f Installation will serve: Residence [�RP �6 K 1.�-�-' �� --- <br /> -_<.._....... ....-...... <br /> Number of living units: . . Number of bedrooms Number of baths . 'Lot size ..-.... <br /> l Community system ❑ Private epth to Water Table/�t. <br /> M Water Supply: Public system ❑ y y Clay Loam��No <br /> ❑ 'aY ❑ Adobe® ardpan❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y <br /> i New Construction: Yes ❑ FHA/VA: Yes [� No ❑ <br /> Previous Application Made: (if yes,dote-. -- .- - --" ....I No ❑ <br /> I <br /> TYPE.OF INSTALLATION AND SPECIFICATIONS: r <br /> I {No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> X77 /0 Mate-al....-...d''. ... .......................... <br /> Distance from nearest we14Distance from found n1- ry.Ca acit �� ..• <br /> S <br /> Tan k�G r �� �duid depth.. "tcapacity Y <br /> . fi /f?�7 No. of compartmants... �- ..-... .Size. j <br /> tP r - <br /> t ��-0_-.--".."Distance to nearest lot line....."-.-- <br /> D;stance from fcundatic�. ..... -. <br /> Disposal Field: Distance from Weare well4 <br /> e6 ¢ T : Width of trench.. ---. ----- <br /> Length of ec+ch lin <br /> Number of lines. �!'. ... I g 'S �.......... ... ........ >� <br /> Type of filter mate•ial .. . .. ..... . . . Depth of filter material- ...� .--. <br /> Total en th...,;Oy <br /> � .Distance om f undatien.l -Distance to nearest lot line--,,. -�� <br /> 1__ / .... p �f De th.....< '�.. <br /> S S79!i <br /> Pit: Distance to nearest w t ` �-ril Size: Diameter... . . • P <br /> Number of pits..-"--- -= - " --Lining material. . .. <br /> . Linin mafenel.._.. --••................. ...... <br /> Distance fi-Om nearest well.......... ......Distance from oundatior..... .....�._.` <br /> Cesspool: ----- ............. L�quid:Capacity.:..........................gals. <br /> I ❑ Size: Diameter .. ... <br /> .Depth .---- <br /> { Distance from nearest we,l _......----•........ ............... .....Dis`ance from nea est building. ...---•--......__.—----------- <br /> ................. <br /> Privy: ................................................ <br /> .... ... ._... <br /> � ❑ Distance `o nearest of i�ne.....................: <br /> - !� <br /> 1 nci'or re airin ascribe}' "T--" .- ............... ._.......................... <br /> ... <br /> Remodeling a - <br /> /r' t'-�"---.-- - - <br /> ..........-f�`'`' <br /> 1 <br /> ..............Y--- <br /> I hereby ce that 1 havespanderedulations off ehe SandJoaquin Lo`calkHea)heDistr District. <br /> accordance with San Joaquin-County <br /> ordinances, Sala Is, anp�rule <br /> l l\1 -- ontrac <br /> -� �, ..{._..��C.. .-._. ..-.. - - .t <br /> or) <br /> •.• .... ............. .. <br /> _. . . . {Titl - - <br /> e. <br /> By:._................................... ......... <br /> (Plot plan, showing size of lot, location of system in vela —to wells, buildings, c�, can be placed on reverse side). —`- <br /> - FOR DEPARTMENT USE ONLY <br /> _ DATE...._.. ----- ._. ..- ......:... ...>....... ... <br /> I APPLICATION ACCEPTED BY------ ..A�.. . !' ..._....••--•.. ..... . <br /> /// DATE.. <br /> E� - �................_...--•-•- <br /> REVIE�NED BY........... ........................:---- DATE..._...... ....... ...................................... <br /> ... ............... <br /> BUILDING PERMIT ISSUED.. ...../� �/...... ................................•-•----•--...._...-•-• <br /> Alterations and/or recommendations:...-. � � .•-_.... ----......................•-••-...................................................... .... <br /> ....... ............. <br /> .......................... .................._........................ ._.... ....:.....:-:'..............._...... ----.-•..... . ...............-•----......... :.........----••......... ...... <br /> .. . - " <br /> / Datd`W., ­ <br /> .. ... ........ - <br /> FINAL INSPECTION BY: -_.. C <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 124 sycamore Street 205 West 9th Street <br /> 1601 E.Ha=eIton Ave, 300 West Oak Street Tracy,California <br /> Stockton,coMorn{a <br /> Lodi,California Mantsco,California <br />