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--------------------- FOR OFFICE USE: �"` � Permit No. __�...---••------... �. �------ -------- --1J_- ...... APPLICATION FOR SANITATION PERMIT ------------- ------- ' i (Comalete in Duplicate r,,,,,^, Date Issue SpA Ih This Permit Ex fires 1 Year From Date Issue rr uin Local Health District for a permit t construct and in`stlf`}he work herein d ribed. Appli anonstereb made to the San Joaq 11 1 ^ This pplo#ron is drib compliancy with County Ordnance No. 544. f� �'_� � r'~ /a low . -- --- Phone ---------- JOB fA-DDRESS AND LOCATION _ 4 ---------------- ------------ ----- e --- Owner s Nam ,il ' �-- - _ a -- _-..------'—_- -------- ------------------------ --- --.__. Addrss.----•- - h .---•---. _ I t � �------ -----•--------------- Phone " ----------- -- 4 Other Contctor's Name._-_..__ Q '� Motel ❑ l�, ❑ Apartment House Commercial ❑ Tr ler Court ❑ -----------•-------- silence ,�j �f.�`�- --------------- - I i; --- Number of baths �_--- Lot size -� InstaiVa�ton wil serve: R� -- � Number of living units: "-- Number of bedrooms Pr+vatDepth to Water Table ' ft. Ct mmunity system ❑ iardpan ❑ Waterupply: Public stem ❑ q ❑ Clay Loam ❑ CIaY ❑ Adobe R Gravel❑ Sandy'Toam Y o❑""°FI A'7� ❑Ngo �• • of 3 feet. Sand ❑ . I No �Neg Construction SY R Character of s it to al�ad�h!of yes�,, te --- - Previous pplilatt � TALLATd`ON 00) ND'SP #&ICATIONS. e witFi 2dd feet.] f 0 TYPE OR INS �,, (N' septic tank or ces3pool permi ed if puliltc ewer is available �� M;eria '" iI tim nearests#a�n/te r�orm�fopn anon Capacity. --0-�------- i Septic Tank: Distance f ° �tme ts_.o-J-Iize Liquid depth_------- No. of compa 9 ----•----Distance to nearest lot line__ -__--_ t _t distace f�ofn foundation- -- n _ � ;,�' __- ...Width ofgtrench "` Disposal Field: Dis#ante from near s�t�"well -- L(en th of,each lin �____.__ ice- Number o?W';nes`1 G-•- - - *. ep}h of filter ma#e --� ` Total len th--- Type of filter{ra�afie is -- � ' Distance to nearest lot i fglindation_-- -- i �I� sa De th.�g istance from Size: Diameter_ Seepage Pit: Distance to n@a..es.,well_. t �-- ----------- P i Lining mtenal_{�-''- Number of it?. II Distance from foundation--------------- - Lining ma#erial_._.____....------ als. Distance fr, m nearest; ell--------:------ -----------Liquid Capacity----------- ' Cesspool t ePth - i Size: Dia eter. Distanee r#o��earest bu-ild.ing f© Distance from nearest wll._.- "° ` - Pr ,,� -- ' - ❑ Distance to neares# lot line------------- - ---------- ------ ' .�-----A9.�---�--' '` ------------------------ 1 k ef s --� `�-� 'w _ � ---------------------------- ----------------- - --------------- repairing (describe --- ----------- -------------------------- 3 05P� - ---.--__- .__-.----------- •-- - ----- --- -� --------------o*-ante with --o-----!---- - -�-- ( `th S q n Cou y � a u' �- _ , . - � � prepared this application and that the work will be done in act d I hereby certif that 0I halve p p ordinances. State laws, aid rules and reguladris of the San Joaquin Local ealth District. ( Contractors ....... - - _ Title_.__ ---- - ------------- + y in relatiot�o e buildings, etc., can be placed on neve rse side). (Plot plan, showing sizef lot, .location f sy . Y F4..R-DEPARTPENT USE ONLY i, ------------------------------- DATE = _ - APPLICATION ACCEPTS BY, - DATE----------------------- ----------------------------------- . _ . ----------- REVIEWED BY------------------- - -•--- DA-TE------ ----------- ---------------- - . BUILDI G PERMIT ISSUED------------- Aiteratibns and/or recommendations-----y, Z2 ---- ------------- ------------- ----- ------------ --------- -------------------------- --------•---------- ------------- 4 -----------------H \;\d -- -- --------------------------- --- --- ----------------- -------- -- ------------- -------- ------------- --------- il ---------------- -------- ------------------------ ---------------------- --------- ---- i /J Date----- -- - ------- �' �✓ -- ---- -- -- BY:.------- . FINAL IN `PECTION: y SAN JOAQUIN LOCAL HEALTH DISTRICT �+�. /.. '; Is 205 Westt9t h.street, 124 sycamore Street 300 West Oak Street Tracy,Calill'04a 3 1601 E.Haxelto ilAve. Manteca,California Lodi,California y } Stockton,California r.P.cn.