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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued --- <br /> Application isherebymade to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> ',ni 'lis application is made in compliance with County Ordinance No. 549./ <br /> 1,6�. - --------------- ----------- - <br /> ---------- <br /> JOB <br /> -------------------- 977 <br /> JOB ADDRESS AN OCAT[ON---- ------ <br /> Phone-- <br /> N tD01-A I 11JN, <br /> ........... ... . <br /> Owners, Nal----- -- ----------------------- - ---------------------------------------------------------------- <br /> ......... ... <br /> Address <br /> -------------- <br /> Phone---------- <br /> Contractor's Name------ <br /> ----- Commercial Trailer Court [I Motel 0 Other [I <br /> -: Residence !4ar Apartment House [] <br /> Installation will serve-Ing units- 91 bar of bedrooms Number of baths __0__ Lot size ----------------------- <br /> Number of living units. Num <br /> I system C1 Private [I Depth to Water Table <br /> Ix <br /> Water Supply: Public system Community <br /> Sandy Loam F Clay Loam 0 Clay [j Adobe Hardpan [I <br /> l <br /> Character of soil to a depth of 3 feet:I Sand F� Grave0 <br /> Previous Application Made: Yes [] No New Construction: Yes No 0 <br /> TYPE OF INSTALLATION AND,SPECIFICATIONS: available within 200 feet.) <br /> )1,�erm'ittecl if public sewer is <br /> (No-septic,tank or cesspol Material------ ------------------ ----------------------- <br /> U well ---------------Distance from foundation <br /> Septic Tank: Distance from near ----Capacity_____------------------ <br /> t Size---------------------------------Liquid depth""Material <br /> No. of compartments_----------------------- I. ----------------- <br /> I __Distance to nearest lot line <br /> Disposal Field: Distance from nearest well_--------------Distance from foundation---------------------Width of french---------------------- ------------ <br /> ------------ <br /> or ----Length of each line----------- <br /> El Number i lines____________ -s----Tota! �ength------------------------------------------- <br /> Type of filter material-------------------------Depth of filter material--------------- <br /> t. -"d io'n-_7�777-_.Disfance to nearest lot line-_---_----------- <br /> -from foun at -----I------ <br /> Di tance <br /> Seepage Pit: Distance to nearest well-------- ------------- Is Depth . ------------ <br /> Number of pits. --- ----Lining material-----------------------Size: Diameter----------------------- <br /> ❑ ------ ------ 0 material--- ------------ <br /> :e from f9Vndation_:/_P---------Lining <br /> from nearest well - - ------- <br /> Distance 15�------gals. <br /> spool Distance 4 h -----------------------------------Liquid Capacity------ <br /> Size: Diameter------'?-------:-------------------Dept <br /> . 9, �� nearest uilding------- ----------------------------------- <br /> Distance fro <br /> 'L-'P'rivy: Distance from nearest well--------------------- -"r ........... ----------------------- ---------------------------- <br /> ------------- <br /> Distance to nearest lot line____------------------------ ----------------------------- <br /> ❑ <br /> -- ---------------------- <br /> or repairing (describe}: - ------ --- <br /> ------ -------------------------------------- <br /> Remodeling'a --------------- ---------- ---------------------------- ---------- <br /> I/V -------- --------- I----------- ----------------- -------- --------- ------- <br /> ---------------------- ----- ----------------- <br /> ----------- --- ----- ------------ <br /> - - ---------------- -------- <br /> Ir ------ ------- <br /> ---------- ------------------------------- <br /> --------- ----- - <br /> ----------------------------- <br /> ------------ --------------------------- ---------------------------- ------------------------------------------- A*\,' <br /> -------------------y certify t + I have prepared i it-application an that the-work will be done in accorda'nc-e with San Joaquin Cou <br /> I her rules <br /> s and regulations of the San Joaquin Local Health District. <br /> ordinances, Stat W a <br /> ;PAT <br /> ------(Owner and/pir ant <br /> 5i <br /> -------------- ---- -- -----91?6�----------�r� <br /> (Signe )----------- I _ I ----------------------- - ?e - - ------------ <br /> 1, k _Y ------------------------(Title <br /> ------------------------- - - -- 'a 0 <br /> By:------------ to wells, buildings. etc., can be pi ed on raver side <br /> (plot plan, showing size of lot, l0caffinof system in relation <br /> FOR DEPARTMENT USE ONLY <br /> DATE------- <br /> -------------------------------------------- <br /> APPLICATION ACq[EEP.BY------------- ------ ------5�- ------- DATE ---------------------------------------- <br /> ---------------- <br /> REVIEWED --------------.BY------------------------ ----------------- DATE _4--- --------------------------------- <br /> ------ ___ <br /> BUILDING PERMIT ISSUED ---------- ----------------- ----V-50------- <br /> --- 4C ------ L_ <br /> 'I _k - C <br /> Aerations and/or recommendations:__-._-., ... <br /> --------------- A -------------- <br /> ----------- - ------------------------------------r- <br /> ---------------------------------------------------- <br /> -------------- ---------------------------------- <br /> --------------------------------------------------------- ------ - -------------------------------------------------------------------- <br /> ----------------I--- -------------------------------------------------------- -------------------------------------------------- ------------I------­---------------- --------I -------------------------------- <br /> --------------- <br /> --------------------- - ------------------- -- ------------------------------------------------------------------------ <br /> r7 <br /> Date------- ------------------------------------ --------- ------------- <br /> ----------------------------------- <br /> ;1CFINAL INSPECTION BY:---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 914 north "CSt. <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street ' -��Tracy,' ba;,itism,ia. <br /> Manteca. California <br /> Stockton, California Lodi, California <br /> FS-11-2M 10-52 Revised W-2100 <br />