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FOR OFFICE USE; No. <br />------------------------------------------ ------------ APPLICATION FOR SANITATION PERMIT Permit <br /> te - <br /> - ------------------ ------- -------------------- -bupl- <br /> ---------------------------------- (Complete if icate) Issued Date Issued <br /> This N x From Date <br />----------------------e--------- --------------------- Permit E Dires I Year to construct and install the work herein described. <br /> Application is hereby made to the Son Joaquin Local Health District for a permit <br /> This application is made in compliance with County Ordinance No. 549, <br /> -------------------------------------------------------- <br /> 61 ------ <br /> -1 ........!��,------------- <br /> JOB ADDRESS AND LOCATION--// <br /> ---------- <br /> ---------------------------------- <br /> C ------ <br /> Owner's Name------ ................. -------------- ----------- <br /> j. ----------­---------------------------................................ <br /> -------------------------------------------------------------- <br /> Address------------- ...............!-------------....... <br /> ------------------------------------------------------------------------------- <br /> Motel ❑ Other 0 <br /> Contractor's Name-— ent 1­18use 0 Commercial [j Trailer Court 0 <br /> Installation will serve: ResidenceN'. Apartm I /j- -----------.......I----••- <br /> I1 -7 Number of baths -------- Lot size ­-------- --- <br /> Number of living-Units: --Z--- �umber of bedrooms -------- <br /> Community syste� E] Private 0 Depth TO Water Table -------- ft. <br /> a <br /> Water Supply: Public system C1 Clay Loam [I Clay 0 Adobe[3 Hardpan 0 <br /> Character of soil to a depth of 3 feet: Sand El Gravel [3 Sandy Loam 0 <br /> No 0 New Construction: Yes E] No [I FHA/VA: Yes [] N a C1 <br /> ------------------- <br /> Previous Application Made: (if yes,date-, <br /> TYPE OF INSTALLATION AND•-SPECIFICATIONS: <br /> within 200 feet-) <br /> permitted if pudic sewer is available <br /> an I /,*e 'I le <br /> No septic tank Cesspool materid ---e-19410--Capacity__._--.---------------- <br /> Septic Tank: Distance from nearest well--A!��`--Distance from foundatio ---------------- --------- <br /> t -X ------------------------------..Liquid clep�h----- ) ----------CaPac' <br /> T, <br /> No.tof compartments----------------------....Size I rest lot line.:�'­­ <br /> 1 1 rest well__/ -----Distance from foundation...A.-O----------Distanee to nearest --------- <br /> Disposal Field: Dist6nce from nea ach line­­JO��------------------Width of trench--- <br /> Number of lines.........-7-------------------.-Length of e �i,j - <br /> ter material-- I N f <br /> ------------Total length---2��-- --------- <br /> El -Depth of fil jf " % <br /> Type of filter materiaL­&�--------- �est lot line-........ ....... <br /> r. . �r Distance to near <br /> i3 - Dista4.'j foun�lafion--------­-- <br /> �Orn --------- <br /> ------ Size:near terial--------:-------------- e: Diameter------------------ ------ ------------ <br /> e of pit.s_y C" <br /> ---------------------Lining ma <br /> El ion -----------­�-----1ining material-------------------------- <br /> st well--------�Distance from founclat' • <br /> Cesspool: Disi�nke-f rom inea rp - -, -------gals. <br /> ?'�, 't ------ Li�Uid,Capacity--------------------- <br /> -Dipt��---------­Z--------------- ----- 11; <br /> ---- --------------------------- I I rest building----------- -------------- <br /> Size: Diarneter3 IL4Di,fanc'e f rom-nea <br /> 0 1 /. 11 ------ ------------- <br /> IS from �-e-&etst well----- <br /> -------- ---0---- I .,;r� �, - ----------------------------------------------- <br /> / ",)r "\. "I ---:­--------------- --- <1 <br /> Privy Distance --------�J­ --------- <br /> Distance to nearest lb7t line---------- <br /> ---------- <br /> --- -------- <br /> 0 ----------------------­----I --- <br /> repairing -------------------------•--- <br /> .- <br /> ------------ <br /> Remodelingand/or ------------ -------------------------------------------- <br /> -------------------------------- ------------------------------!­7 7--------- ----------I- ------------ <br /> ------------------------------------------------ ---------------------------------------------------------7------------ <br /> ----------------------------------------------------------- ----------------------------- <br /> -------------------- ------------------ ------------ --a�cordjn­ci-With San Joaquin ,County <br /> ---­---------­--- 4 d�n­e j� <br /> ---------------------------------- prepared this application and that the worlFwilF�e <br /> Joaquin �o�a-1 Health District. <br /> I hereby certify that I have .nd-egulations of the San Jo <br /> ordinances, State laws, and rules a I r <br /> ------ ------------------------ ---(Owner arid/or Contractor) <br /> 4,ov7h azv -------- ------------ <br /> ---- ------- ------------------ ----------------------- ------- ...... <br /> (Signed)....... ....5"--' ?�19'9- 0 <br /> ? -------------------------- <br /> -.(Title)._ <br /> ----­-------------r----i <br /> By,--------- ... ........ - ------ ----I---------------------------- reverse wells, 64ildings,-etc., can be pIbced on slide). <br /> n off system in relation to <br /> (Plot plan, showing size 0 0 . c <br /> FODE ARTM T E ONLY <br /> E------------1�;- ...... <br /> ----------------- <br /> -- ----- ------------------------------ <br /> APPLICATION ACCEPTED BY---------- ------------ ------------- <br /> DATE----------------------------------­­-74�1I <br /> ----------- <br /> REVIEWEDBY-------------------------------------------- -----------------•--;-------- -------- ------ DATE--------------------------------- <br /> BUILDING PERMIT ISSUED-.._..-_..------ ---------------------------- ---------- <br /> -- -----­-------Ll��----------- = --Alterations and/or recommenctations:------------------------------------------- ------••---•---•----•-_--•--------------- .............. <br /> -------------- -------------------------- --- -------------- ---- -------------------------------------------- <br /> --------------------I........... --------------I......... <br /> ------------------------------- ------------------------------------------------- 1! <br /> ------------------------------------------------------------------------------------------------ ----- ------ -------------------- --------------- <br /> --------------­-I----------------------------------------------- <br /> -------------I- ------------------------ ------- ------------------ - ----------------------- <br /> --------------------------I--------- .... ---------------------- <br /> i ... -------------------------------- -------------- <br /> ----------------------•--•--....--•-.-•--- ------------- 13 <br /> e--. 3 <br /> Dot <br /> FINAL INSPECTION BY----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> T <br /> 124 Sycamore Street 205 west 9th Street <br /> 300 west Oak Street <br /> 130 SouthAmerican Street Lodi,California Manteca,California <br /> Stockton, Tracy,California! <br /> California <br /> ES 9 REVISED 5.59 pM 5-62 ATLAS <br />