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4 <br /> 7-7 <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> i (Complete in Duplicate) _ <br /> ...,..l <br /> �-� Date Issued � �1<-�•�./.:(,�c�c.J E�/L-S',�IGsL�(dF�,� C7S <br /> Application is hereby made to the San Joaquin Local Health District for a permit to �p -13 <br /> construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> Lower Sacramento Road and <br /> JOB ADDRESS AND LOCATION_Tokay Drive Inn Theatre : Armstrong Road, Lodi. <br /> ------ ---- --•-------------,----,,-------- ----------------------------- <br /> •-- -•---- -- ------------------------------•----------•----------------------- <br /> Owner's Name______Sacramento Amusement & Development Company Lodi 8­--0305 <br /> -------------------•--------------------------------------------- ------ ------. Phone----------------- <br /> Address__-_Z76--Golden_ Gate Avenue., San Francisco <br /> ------------------•--------------------------•---------------------------------------------------------•-------------------- ----------•---------- --------- <br /> Contractor's Name_____.-D-._._A. .P-ARRISH & SONS, INC,, ., <br /> --------------------- ----------- - -------- ---------- ---------- Phone_-9"g607---•----------- <br /> Installation will serve: Residence ❑ Apartment [❑ Commercial <br /> * artt H ;�] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _?----- Number of bedrooms _-2-_ Number of baths 2__-__ Lot size ...2a_-A_Cr!e_s <br /> P _ t <br /> Water Su I y� sysCommunity. Public fenQ4P system ystem 0Private +� Depth to.Water Table 2O� ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cla <br /> y ❑ Adobe IN Hardpan-n 1 <br /> Previous Application Made: Yes ❑ No EX New Construction: Yes,& No ❑ "p <br /> _.TYPE OF INSTALLATION AND SPECIFICAT-1QNS: — <br /> (No septic tan`k or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.____bq 1_--Distanc from foundation-____ _ i <br /> • �-�-------.2�rial CC Brick _ <br /> X -------- ----- ---------- <br /> No. of compartments___--�------------------Sizeg6" __ Liquid depth_-�-----_ --- IaQO-- <br /> q tXeep-- ------Capacity.-1-00 PC --------- <br /> Disposal Field: Distance from nearest well------ ---- .Distance from foundation_ 65 - Distance to neares2lp line___10-1----- <br /> I 1 140 t--- • -------- tsa ' <br /> Number l lines------------------gi --_--_ Length of each line-__-_-_------ Width of french--____-- ------------------------- <br /> Seepaqe Pit: <br /> - ------------------ <br /> Type of fitter material__.____._._-Rk---Depth of filter material_-._ lOQ} <br /> -----------------Total length-------------------------------------------Pit: Distance to nearest well____1 ?-_--___Distance from foundation___1501 x <br /> - CC Brie ,����Da to neares �__ <br /> Number of pits------- ------------Lining material----_----__.--___----__ e: Diameter__-_--_ <br /> -------- ----- <br /> ---Distance Distance from nearest welP_ . Distance from foundation--------------------Lining material_________________ <br /> ❑ Size: Diameter---- ----- .Depth----------------- ------ <br />. � i Ca <br /> Priv -" --= - - -_ t" - - - -- ------ <br /> :� qui Capacity <br /> -----------------gals. <br /> w,� Y Distance from nearest well __-.__------------------------------------------" I)!s} e from nearest buildin' <br /> - - x <br /> Distance-to,nearest;lat.line------------------- <br /> g----------------------------------------- <br /> ------------------------ -------- <br /> Remodeling and/or repairing (describe):_____This system IS----------- deSigned to ha.xldle .,$ c071templated= . <br /> - - --------------- -- ------ <br /> -------------------------------------------- --------------------future addition of tiro or three sho--------or sores-,----------- ------------------ <br /> --------------- <br /> -------------------- <br /> -•---------------------------------------------------------------- ---------------------------------------------------------------•------------------------- <br /> ----------------------------------------------------------I---------------------------­­----------------- <br /> ------------ - --- -- -- - - - ------ ----------- r <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--------- D_a_-- '---P F'TSH & SONS INC <br /> --------- (� �} r Contractor) <br /> -- <br /> ----- <br /> BY:- --- -------------- F <br /> (Plot plan, h ing size of lot, location of sy em in relation to wells, buildings, etc., can be placed on reverse side). <br /> t FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ <br /> -- <br /> - - ---- - -- -- -- DATE�------------- <br /> -------- <br /> REVIEWED BY --- ----- <br /> < .- - <br /> ----------------------- ------------------------------ - DATE <br /> _ Sa . <br /> BUILDING PERMIT ISSUED_--_ - �-------- <br /> --------- DATE-------- <br /> Alterations and/or recommendaflons-------------------- ---- ;------------------------------------------------ <br /> ----------------------------.------------------------------------------------------------------------------ . <br /> ------------------------------------------------------------------------------------------------ ------- <br /> ------------------------ <br /> ------------------------------------------- -------------- -- <br /> _____________________________________ <br /> ___-.._.____---_ <br /> --------------------------------- <br /> __________ ______________________ <br /> FINAL INSPECTION BY <br /> - Date.------ ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street <br /> 132 Sycamore Stree} 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California <br /> Tracy, California <br /> ES-9--2M B-51 Revised W-2 f 00 <br />