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FOR OFFICE USE: <br />...... ..................... ........ Permit No,APPLICATION FOR SANITATION PERMIT <br />4 <br />........... (Complete in Duplicate). Datei'lssu$8 <br />This Permit Expires I Year From Date 115'suod 1 4 <br />San Local He a construct and i nsta 11 the *rk hoteik C60. '11., <br />Application is hereby made to the mlt�. District for a permit fi <br />C <br />This application Is made in compliance Ii <br />bnce with <br />JOB ADDRESS- AND LOCATION�.�,,;,��.* Vell r 8. ...... <br />Phone... <br />.. .......... <br />Owner's Narne­.. <br />Add....... ........... . ..... <br />one,....,.. ............ <br />Installation will serve- Residenceidence C] Apartment House ❑ Commercial Trailer Q!j Motel Other n <br />i Number of living units: Number of bedrooms Number of baths .1—. Lot size <br />Water Supply: Public system Community system [] Private �j Depth to Water Table <br />Character of soil to a depth of 3 feet- Sand C] Gravel F1 Sandy Loam j1d Clay Loam [-I Clay C] Adobe C] Hardpan f7 <br />Previous Application Made, (if yes, date ... .... 'No �R Now Construction: Yes T No f—1 FHA/VA: Yes r7i No [I <br />1i <br />TYPE OF INSTALLATION AND SPECIFICATIONS - <br />wit <br />Sep sspoo 'Petmi i i pUbIte %swar is availibli Wth-2WfAl.j <br />Septic Tank: Dit !I stance fromi,nearest we,14'�,!'� ..... Distance frcm f8un0'afion--/.9-.__ .... Mate <br />No. of compartmenisC6 ..............Capacity........_......_...... y <br />Disposal Field.- Distance fromineare.,+ well­ci+- <br />.0Di1 <br />stance from to nearest lot Iin9­v1r!­7? <br />Numcer of lines. ....... Length of each line /l ".—, Width Of trench -- <br />T..... " <br />Type of filter mater. ;a rWi,, <br />D 'th 0 f filter <br />ata! length Z" <br />p <br />------ <br />Seepage Pit: Distance to nearest well...._.._,..,.1. to nearest let line ..-Distance from foundai;on.. <br />Number of pits--, .....LiniAg material— .. ... Diameter, D0Pth­­­­­ .y <br />Cesspool, Distance f,-om'!nearest well!-..--.- Distance from 161,inclaition ....... ........ <br />E] Size: I ............. ......Depth .—, ..... . ... la Capacity <br />f! I o,from nearest building ... .. . ....... <br />Privy-. Distance,from, nearest well <br />11 ­­ .... ­--, Distance t <br />nearest lot lir .......... <br />Distance to n lire... . .............. ...................... ......... <br />Remodeling and/or repa,ring (describe)--........--., ............... . ......... ........ <br />.......... <br />.......... <br />....... .. .... ....... 1A <br />----- --------------- ............... <br />. .................... — - ------- .............. ... <br />. .......... ......... ....... <br />­­­­ I .- hereby ­ certify ­ fha . f I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, Slate laws, and rules and egulations of the ,San Joaquin Local Health District. <br />------- (Owner and/or Con+racforl <br />{Ti <br />(Fiat plan, showing size of lot, location of system in relation to wells, buildings: plc,, can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY.. <br />REVIEWEDBY.... ....... ­­ ........ .... - ---------------- ...... ...... DATE- ....... <br />TE.- <br />BUILDING Pe9MIT ISSUED— --3 ............ ...... ... ................. ............. I DA ............ ----1 ...... <br />Alterations and/or recommendations- ....... ......... <br />............ ....... .............. .......... <br />... . ...... . ................ ........... ....... ......... <br />FINAL INSPECTION BY:... ".,.- ..... . <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />i 6o 1 1. "suabon Avv. 300 Wee 0,0k street 124 Sytiontam SOW <br />Stockton, Cofif*rmio Lodi, ccilifornia C*fl#6,v%;0 <br />I i, <br />............ 1— ......... ­ ...... <br />.............. <br />205 Wert 9th Street <br />1'tmy, CoNfornio <br />