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~ , <br /> 1\0 <br /> APPLICATION FOR SANITATION PERMIT Permit No. ........ <br /> (Complete in Duplicate) <br /> Date Issued <br /> the San Joaquin Local Health District forpermit to c ,+ c+ and install the work herein dosc,|6o6 <br />/ U ' ' complianceis application is made in with County Ordinance m <br /> Owner's Ncime---- <br /> i <br /> Contractor's <br /> Motel Ll Other E] <br /> mo/ ,=" will °=,=^ .~~.~. ._. i___ ^~ �� __ El� � <br /> , --_-'- <br /> Num6o, nf �e6mnm� � Number baths Lot ^�xNum6ar of living units- <br /> Water <br /> n�s� <br /> �� Supply: ��� ��mCommunity system E].� Piriva te'E] Depth to. Water Table Cv�[ <br /> Hardpan []Chm er of swUf* mdepth 3 feet: Sand [ Gravel ;Sandy Loom [] Clay Learn E] ` <br /> Previous Application Made: Yes 0 No o�wc`tio~n`- Yes ] N-k <br /> TYPE 'Of <br /> | <br /> INSTALLATION AND �P6�iFV��T��N5� <br /> ' <br /> (No septic tank or cesspool permitted if public sewer is available.wifhin 200 feet.) <br /> Septic Tank: --Distance from nearest well ' Distance from foun6utioh-------------------MoteriaL----------__^--_- ' | <br /> Disposal ' '~'v <br /> �* Distance-- -- nearest- - - <br /> �, Num�er�o�|�os -' "+k <br /> of each line Wi6th of ------------------------------ <br /> Type <br /> �-'_____th <br /> ',r- _ <br /> - filter <br /> Seepage ' ^' <br /> Distance to neairest <br /> ~~ - '� <br /> ''-'n|�g �e D�^mot�� � ` Dopth Depth. -�-Num6or of p��. - -�'''fu . <br /> Ces`noo; - D�s+ nce`fmom� nearest well <br /> '_----------Distance fnnnfounduflnn--''-�| -U �g ^mofa�n| � <br /> -� -'-___ <br /> - _-..gu|,.� . � _ r .�� C�6 - " - l5n6+y------------ .. <br /> El <br /> . <br /> '^ rivy: Distance from nearest weL-'_---.__---�-,--D�tunce fn,� nearest building .-----___---'_ � <br /> | |' <br /> �� ~'^'~'~` - ---rest ine----- - � \ <br /> �m . (6� ����-- -' '' ^ ' <br /> � Rcmode|ing "ond/6r'��u�ng ,�c��-,_''- ----------------------------------------I—— '_--_-'----'-----' <br /> ` '---_-'-_'-_--'-'_-.--__...__._-''-.�'--_-_.._-.--_...__.---_-__--_-^--___-�'__-_-'�_-, - <br /> ' ---'--'---"- <br /> ------------`---,-------''-----------'----'--'----''---'''---'----'�'�7-'-- <br /> -_-_-'_''--''���'__--___'-__-'----___---_.-_---__-'-'-__-_-''�-''-_'-_'--''-'-'---. <br /> I hereby certify that I have prepared This application` -----'' and that be dn] with San Joaquin,County <br /> ordinances, State laws, a r s and regulations of the San Joaquin Local Health Distrid� <br /> ' <br /> ` (Sig7--(Owner aiid/or Contractor) <br /> . <br /> (Plot plan, showing size o of. location of,system in­relation to welli, buildings, etc., can be pi�l e <br /> ----- <br /> FOR DEPARTMENT USE ONLY . <br /> ' ' P-- - ACCEPTED <br /> ux/,� <br /> REVIEWED BY----------------------------- <br /> ----------------------------- --------------- <br /> J^ BUILDING PERMIT ISSUED--------'-�����'_-'^~`-''__-__--'____________.____ ��`.�____�----------- __ ------------------------------ <br /> ' <br /> Alterations A6/o, ,eoonnmondm+imnm---------------------------------------------------------------------------------------------------�- -------------:-------------- ----------- _ -------- <br /> -----'---------------------'---'---''---'-------'----'------'---------'' <br /> . <br /> ----------------------------------------'--_''��-''''''-''--''''-'''''-------- ----------------- ---- --------------------------------------------------------------------------- <br /> � _-..__._-_--.---_-__--._--'---.-----'_--_-_--_--._----_-_-----.---._---- <br /> �--'-''--'''--''--' '-' ---'-'''' --------------------------------- <br /> . � <br /> Du+o � / �' ' <br /> FINAL INSPECTION BY:--------------------- �-------------- � '�-'-'�,r'-''---' -''-''-------. <br /> . SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> on s*mm American Street 3ooWest Oak ew°* oz s'*"mom ere* . o|+ N"*h "C" Street . <br /> Stockton, California Lodi. Ca|'pf"rnim wanvo^o. California nw*'. California <br /> , ~ <br /> ' ss-9-2w w-52 Revised vv-2/00 <br />