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'APPLICATION FOR SANITATION PERMIT <br />(complete in Duplicate) <br />Application is hereby made to the San Joaquin Local Health District for 49, a permit to construct and, install the work herein described. <br />This application is made in compliance with county Ordinance NO. 5--------------------------------------------------------------------- <br />LOCATI�p ----- �_� ---- -- --------------- phone <br />JOB ADDRESS AND I F. _ -------------- <br />----------------------- <br />------------------------ ---------- <br />Owner's Name--- - - -- ------ -------------------------- <br />----------------------------------------------------------------------------------- --------- <br />Address ---- - --- -- - ---------- - ----- - Phone--.,-.- <br />--- ----- Motel E] Other [I <br />Name-"_.____ R . Residence FN Apartment House El Commercial El Trailer Court [I ----------------------- <br />.Installation will serve: Number of baths Lot size-- ------- <br />Number of living units: Number of bedrooms a_ V <br />4Private <br />Water Supply: public system [] Community system 11 :,X ClaLoam El Clay El Adobe' Hardpan El <br />Character of soil to , depth of 3 feet: Sand D Gravel El Sandy Loam 0 y <br />is <br />TYPE OF INSTALLATION AND SPECIFICATIONS: . <br />(No septic tank or cesspool permitted if public sewer is available within200 feet.) <br />/ewer <br />from founclaiion ------- ------ ------- <br />Septic Tank: Distance from nearest well,_'Zo-- --- Capacity ---- tT� ------- Size — ----------------- Liquid dept --- <br />No. of compartrnents___-�� ------- t _W <br />Distance from found8 ion --- -- - ----- ---- Lining materia <br />04��� Distance from nearest well-- ---- <br />esspool: Size: Diameter--- ------------------------------------ Depth ---------------------------------------------------- <br />Cl Distance from nearest well"__"-------------------------- ------------------- Distance from nearest building ------------------------------ ---------- <br />Privy: Distance to 'nearest lot line ----------- # ------------------------------------ <br />aresf well Dista cc- f�o m f �ol a.,zii n ------- S -------- Distance to nearest lot line- <br />--------------------------------- <br />e Pit- Distance to. nearest ------ mat10 Siz, ----------------------- Depth <br />Diameter <br />Seep Lining e ial- <br />Number of pit, ---- -- / ------------- �4_ ------ ----- <br />+ Distance to nearest lot line --- ------ <br />e from nearest well___"_.___ ------- Distankcer anon"-- ---------- Vidth of trench ----------------------- - ----- <br />i Disposal Field: Distance <br />A Number of lines------------ ------ -------------- Length of each line --------------------------- <br />-------------------------- ep+h of filter material --------------- --- <br />Type of filter material <br />deling and/or repa--------------------- <br />------- <br />----------------------- ---- <br />Relin a ,9 'U, - ---- -- -- ----- ------------------------------ <br />obdeling and/or repa' Ing (descri --- --- -- <br />-- ------------------ --- ---------------- ------------------ <br />------------- <br />- --- -- ---- --- ------------------- --------- ---------------- <br />------- ---- <br />-- ----- ----- -- ---------- <br />----- ------------ ------------------------------------------------ <br />--------- -- --- ---- ----------------- -------------------------- <br />- ------------------ ---------- ------ ---- - ------ ---------------------------------------------- . <br />....... ork l be done in accordance with San Joaquin County <br />prepared this application and that the w <br />I hereby certify that I have <br />_ord_i_n_a_n_Ces_,S`l?_h1ja_ws ------------ rul- _s-_ and- _r_e`g­uons of the San Joaquin Local Health District. <br />- ------- --- <br />----------------------------------------- .(Owner and/or Contractor) <br />(Signe --- --------- ----------- --- 7� - - ___ ­_.�_;_; - - <br />- - --- -------------------------------------------------------- (Title).a�, nl,.� <br />,y ---- ----- -- --- ----- -- etc., must be filed with this applicatie <br />f. <br />(plot plans, s owing si location sys in relation to wells, buildings, <br />---------- FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY --------------------------------------------------------- ---------------------------------------- D,�,TE ------------------------------------------------------------ <br />rm DATE ------------------------------------------------------------ <br />--------------- -------------------------------- <br />REVIEWED BY- ---------------------------------------------------------------------------- ------- <br />APPLICATION <br />---------- <br />.VKA - ----- <br />BUILDING PERMIT ISSUED ---------------------------- ;R - - ------ 60-10 . ....... <br />- - ---------- -- <br />Alterations and or recommenda on : - --------- VrAAJ`�t^"' 4 -- ---------- <br />it) A ) ------------- <br />ev� ------- <br />------ - - --------- r <br />Ac_Xr- - - - I . ------------------ <br />-- ---- ---- ------------- <br />--- - - ------ ------------------- ------- -------- <br />--- /a __ - ----------------------- ----------- ----------------------- <br />------------ ----- --------------- ------------ ------- <br />- d - <br />t 0/_;r4 ------- (Date) FINAL INSPECTION BY--- -------------------------------- ---=--- - -------------------- <br />ISSUED"- -------- <br />PERMITDate--------------------------------------------------------------------------------- <br />v' <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />71 <br />130 South American Street r <br />Stockton, California <br />ES -9-2M 9-50 W-1639 <br />