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APPLICATION FOR SANITATION PERMIT: � ��`� f , Permit No. ------------------ (complete in Duplicate) Date issued _ -{`� ri al Health Dit for,a permit to construct and instal4 the work herein described. is hereby made to the San Joaquin oc Application on is,made-in compliance with County Ordinance No. 549. This application I -------------------------- JOB ADDRESS AN LOCATION--_ V Phone------------------------------------ ---- ------ ---------------- Owner's Name----,V ---- ------- ----- ------------------- --- ----------- --------- 0-52–------- --- - -- - -------------3- _'Phone------- ------- ----- Adclress!__Z�l -------- ------------------- --- ------------------------------ Contractor's Name------------------- ------- - __ P Motel [] Other Installation will serve: Residence 0 Apartment House 0 Commercial 0 Trailer Court El M-6---—------------------ of baths 2---- Lot size ---LIQ -- ---- ---- Number of living units-- -------- Number of bedrooms Number enableClaferin [I Private 0 Depth to Water, .11 ❑ Water Supply: Public system Pk Community Sys Gravel [I Sandy Loam n Clay L [] y 0 Adobe�% Hardpan Character of soil to a depth of 3 feet: Sand 0 New Construction: Yesk�_No [I FkA/VA: Yes ❑ No Previous Application Made- Yes E31 No 10 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if, public 5 wer is available within 200 feet.) iMaterial----h-----'---------2 ----------- ---- rest 'well-V --Distance from foundation__ Distance from nea --- Capacity---- Septic I Liquid clep��-------I/--------------- No. of compartments----a--------------- -.Distance to nearest lot line------- ------- Distance from nearest well;;?�P_(,� : Distance from foundation Disposal Field: h line----/.0_0-------- ------Width of trench., --------------- --- Length ofreach Z materia 0 Number of hn6s' ,___3 -------- 3+b------- Type of filter - --------- Depth f fi�ter material__ ----Total lenc 417 ''Distan e to near st lot line___ --.----- ' ine----- f un ation------ V 0 n U Distance ------ C! )_� Distance to nearest well_ _.. e --------------------------------- Seepage Pit.- e: Diameter--. epfh of pit' Linin mat _4 Number --------------Uning mat j �1\ "%— 11-----------------Distance fro foundation- -----------------Uning material--------------------------------�als. Cesspool-, Distance from nearest we Liquid Capacity----------------------------9 .1 -----------------Depth--------------------------------- ------------------ ..Size. Diameter[ Distance from nearest building_____._.---------------------------------- Distance from nearest well------------------- ----------------w--------------- fV ------------ Privy: ---------- ---- ------------------ Distance to nearest lot line--------------------------------- --------- i - _1 0 1 -------- --------------- ------ repairing (cle! ---------------- scribe)- Remodeling and/or, ------- - --- ----------------------------------- ---------- -------------------------------------- ---------------- ------------------- ------ ------------------------------------ --- --- -- -- ---------------------------------------------- ------------------------- --------------------------------------------------- ------------------------------------------------------------------------ nf ------- ----------------------------------------------------------------------- that the work will be clone in accordance with San JoaquinCou y I hereby certify that I have �repare-d this application and a s of the San Joaquin Local Health District. ordinances, State laws. and rules and regulation (owner ai�cl/or Contract ------------------------ ------------------------- Sn ----------------------- ----------------------------------i; --------------- igned) (rifle) --------------- eBy:-------------------------------------- --------------------- wells, buildings, etc., can be placed on reverse side. size of lot, location of system in relation to (plot plan, showing A FOR DEPARTMENT USE ONLY --- DATE-- -- ----------- ------------- ------------------ APPLICATION ACCEPTED BY------------- APP . .... !:�---1;�_ 6__/_ --- ---- DATE___ )_ REVIEWEDBY--------------------------------- -------------------------- -------------------------------------------------------------------------------------------D----A-----T-----E---------------------------------- BUILDING PERMIT ISSUED---------------- ------------------------------------------------------------------- ---------------- -------------------- Alterations and/or recommendations:` ----- -- -- ---------------/ ---- --- -- -- ----- - ------ ------------------------------ -------- ---------------------- --------------------I------------------ ---- - - -----------------------:------------------------------------I-.-.-.-.-.-.-I----------------------------------I-------------------------------------------------------------------------------------------------------------- ------I------------- ----------------- - --------------------- -----------------------------------------------------------------------I--------------- --- -------------- ------------------------- i---------------- - ------- ------------ ------------------------------- ------------------ Date------3-------L-79--- -- -------- --------------------- FINAL INSPECTION By ---IL -1-------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North ,C" Street 30o west oak Street N 132 Sycamore Street Tracy. California 130 South American Street Lodi, California Manteca, California Stockton, California ES-9-2M . Paviseo )-57 FY.CO.