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'\lo c� APPLICATION FOR SANITATION PERMIT Permit No. ..."•1"-"�_-- ---•- 7/� mDuplicate) (Complete Date Issued ______________________ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 4 , C ------ JOB ADDRESS AND LOCATIO ----------- - Owner's Nam ___ --- _ ��------------------------- Phone /� �-�- ------------------------------------------------- -------------------------- ----------------- ------ Phone- --------------- -- // ------ Phone----------------------------------- --------------------------------- Contractor's Name------------------- •--- � L_W g r Motel Other Installation will serve: Residence Apartment House ❑ 'Commercial ❑ Trailer Court ❑ ❑ [I Number of living units: _ ___ umber of bedrooms Number of baths -------- Lot size ___ Water Supply: Public system ^ community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet. Sand.❑ ..Gravel E] Sandy Loam F1 Clay Loam El Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No �ew Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No se tic tank or`cesspool permitted if public sewer is available within 200 feet.) 'I Material--------------------------------------- ------ tic T 11, k: Distance from nearest well____._._-.______Distance from foundation_"___________.__ _. _-Li Liquid de th__________________._ Capacity No. of compartments---------------------------Size-----•--- --------------•---•- q p. ---- ----------------------- well- ----- ------ - �__d__ __"Distance to nearest lot line---.57 pas Field Distance from neare t well__ .Distance from foundation___ _ Number of lines___.____41� ____Length ofeach line_____ Width of trench.__" 4"--------------- Type er filter maferia __ Depth of fil}er material--,/ _ :.____ otal length__ ________.."_______________""-- �o Seepag it: Distance to nearest well___57!!w -Distance om foundation______ _�o Type to nearest lot line-- - Number of pits_____ _ .--______ Lining material_ -_____ _ _Size: Diameter_., _ "_-" .- -.Depth--------As 7-------------- i{ Cesspool: Distance from nearest well__--_-.________Distance.from foundation----------_---______Lining material__________._____________- --------- ❑ Size: Diameter------------------ -----------_...--------Depth-------------'----------- -------------------------Liquid Capacity_.--------------------------gals. - ----------------------- - Privy: Distance from nearest well___.___----------------------------------------Distance from nearest building---------- _______-------------------- Distance ❑ to nearest lot line_..___"""------"----------- ---------------- ----------------------------------------------------------------------- i Remodeling and/or repairing (describe)-------------------------- --=-------------------------------------------- -----•----------------• -----"---------••---------------- ------------------•-------------------"----------------------- -----"____.-------- •-------------- - ______ -- -----------•------------------------- ---------•--------------- ----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ounty ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. DAY& NICHT �./.or Contractor) (Signed)------- '' ---------------Salstir-T�x�s�-SRr�Ec�-------- ----------- - -- -- ---- ------------------------------- --- 1206 So. Eldorado HO 2-704 !_ (Title) d�f7�'¢ f By_ ----------------------------- _. (Plot plan, showing size of lot, location of -, em in relation to , building , etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.......... DATE \k� *---------------------------------------- REVIEWED BY I_. DATE BUILDING PERMIT ISSUED--------------'----- - - DATE-------- -----------------------------"-------------- -- Alterations and/or recommendations:---------------------------------------- --- A - = r ----------- — ------- ------------------------------------------- --------------- -------------•--------------------------- - ---------- .,3a r �- Ar 7 f1 = J �--- v --1�� Y ------ ----------------------------------------------------------------------------- �-" -.- •-----------------ice - ------ --- --------------- - Date.- ---�-�-------- ------------- -------------------------------------- FINAL INSPECTION BY:__� ... ----------- -"-" - ---__----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P.Co.