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Permit No. ---- <br /> APPLICATION FOP, SANITATION PERMIT sued --- /4 <br /> (Complete in Duplicate) Date Is <br /> described.Jto construct and install the work herein <br /> rApplication is hereby made to the San Local Health District for a permit I.janr -1th County Ordinance No, 549. <br /> This application is made in compliance w -------------------- ------ <br /> IQ--,:,---------------------------------------- <br /> -------------7 Phone--------'-T------------------------ <br /> JOB ADDRESS AND LOCATION-. ---- ------------- ---- - --------------------------- <br /> ---------- <br /> --------------- - - ------------------------------------------------ <br /> ------------- <br /> owner's Name--------------- 0--e4- ------- --------- --- <br /> :;X----- ----------- 0A7----- <br /> ;;�' 7 (/ Phone----- <br /> Address_---------------------------------- ------- . .......................... <br /> Contractor's Name____________________ ------ 1-�_ ---��4_ - Motel C3 Other [I <br /> Apartment House 0 Commercial [] Trailer Court 11 <br /> Installation will serve: Residence X Number of bath, ---t--- Lot size ___? - --------> ------------------------ <br /> Number of living units:, Number of bedrooms Water Table W9_ ft. <br /> Communify system [3 Private ❑ Depth to, Adobe M Hardpan [I <br /> Water Supply: Public system Sandy Loam 0 Clay Loam ❑0 Clay 0 <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel 0 1 <br /> [] No %I New Construction: Yes [] No El <br /> Previous Application Made: Yes <br /> TYPE OF INSTALLATION AND.SPECIFICATIONS: available within 200 feet.) <br /> (No septic tank or cesspool permitted if public sewer is ce from foundation--------------------Material-___._._--- ------------------------------------ <br /> S tic Tarik: Distance from nearest well_______-----"--- Distan ---Liquid de0b-------- ----------------Capacity-------------- -------- <br /> Size----------------------------- <br /> I t�40. of compartments------ ------------------- ndationlD nearest lot line---5--•-------- <br /> r <br /> ine---:�----------- <br /> Distance +4 <br /> Distance fi,or� nearest well_/�F�f�---Distance from fou Width of french----- ....... ........... <br /> Disposal Field or lines Length of each line !.--­0-7�-"T -------------------- ---4 <br /> Number I lines.------/.-----...... - ------------ f filter maferia�------4.0-----------Total length- ------- <br /> "-------Depth 0 ------- <br /> Type of nter material--/ nearest lot ;'nG--- <br /> f foundation--/*---..._Distance to ne <br /> Distance to nearest wO!--- ---Distance rOM , I----13-all--------Depflh_2;��------------------ <br /> Seepage Pit: <br /> Number of,'its--------/-----------Lining maferialepW......Size: Diamete <br /> p I <br /> 91 clation '----_Uning rnateriaI-------- ---------------------------- <br /> Cesspool: Distance from nearest well----------------Distance- .-from-o-m -0-u-n------------------------------Liquid Ca .acs ------------------- --------gals. <br /> S-�7e:�Diiarneter.--------------------------------------Depth .-- -- . -- - -- g <br /> F1 ..........Distance ivorn nearest building------- --------------------------------- <br /> Privy. Distance from nearest well---------------------------------- --------------------------------------------------I------ <br /> Distance to nearest lot line_-_.-_-------------------------- ------------------------------------------ <br /> ❑ <br /> -------- ------ <br /> Remodeling and/or repairing (describe): �y ------------------------------------------- <br /> ---------- - <br /> - <br /> - <br /> - <br /> - <br /> - <br /> ---------------------------------------- ------- ----------- <br /> ----------------------------------------------------------------- -- ------------ ----------- <br /> ------------------ <br /> --------------------------------------------------------- <br /> ---------- <br /> ---------------------------------------------I---------- ---------------­-------------- ------------------------------------------------------------------------:------------------------------------- <br /> --------------------------7 -----------------------------------------­ e in accordance with San Joaquin County 1 <br /> 1 hereby ce�,_t�),y that I have prepared this application and that the work will be don <br /> S J I -'the San Joaquin Local Health District. <br /> 'ws and rules and regulati , Qf <br /> ordinances, ons <br /> 17 0:W"WjWIP5,r Contractor) <br /> ----------- _71 <br /> �L ---- <br /> - --------- <br /> (Signed)----------it ----------------------------------(Title -------- --------------- <br /> By:-------------------------------------------------------------------- - --------- etc., can be placed on reverse side]. <br /> (Plot plan, showing size Of lot, location of system 1------ <br /> - <br /> (Plot w Is, buildings, <br /> FOR DEPARTMENT USE ONLY <br /> DATE---- -------3. A1a."T_____31___�----------- <br /> -------------------- ------------7----------------------------- P-tv <br /> APPLICATION ACCEPTED BY ---------- -------t�- ----7-- --�_�_ -TF----- <br /> DATE------------------------------ ------------------------------ <br /> REVIEWEDBY-------------------------- -------------------- --------- ---- DATE--------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------••----------------•--------------------- --- <br /> ----------------------------- <br /> ----------------------------------I----------- <br /> Alterations and/or recommendations:--------------------------------------------------------------------------------- -------------­----­---------- <br /> ---------- ------------------ --------I-----------I------------------------------------------------------------------------------------------ ----------------------------------------------- ------------------------ <br /> ------------------------ -------------------------....... ...................r------------------- --------------------I--------- ---------------------------------------- ------------------ ---- ------------------------- <br /> -------------------------------------- ---------:------------------------------------------------- <br /> ---------- --------------------------------------------------------------------------L--------- <br /> -----------------_------------------------------------------------------- ----- ---- ----------- -------- ---------------- ------------------------------------------------------------ ------ -------------------------- <br /> ---------------------------- <br /> 41� Date-----------5-- ---- --------- <br /> FINAL INSPECTION BY:_'!--------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street $14 North "C" 5tre4A <br /> 130 South American Street <br /> TracCalifornia <br /> Stockton, California Lodi, California Manteca, California y, <br /> ES-9-2M 10-52 Revised W-2100_ <br />