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�¢ Permit No. _(R_=Ll'------ <br /> Ir APPLICATION FOR SANITATION PERMIT <br /> 1 (Complete in Duplicate) Date Issued <br /> -S-15- l <br /> 1Joaquin Local Health District for a permit to construct and install the work herein described. <br /> Applica`ion is hereby made to the San <br /> y <br /> This application is made in compliance with County Ordinance,No. <br /> 549. <br /> = , IL <br /> 0 ----- <br /> JOB ADDRESS AND_LOCATION--------3-��� �_ 4_ U__-,�_ �_ �F'G,�--------------- �_ , <br /> t �... : C, -------------- ,� - - - . <br /> Owner's Name---:_...:-_ -•- _. .: # c. <br /> z. .. -•----- -----•----- <br /> - ----- -------------­------- --------- <br /> Address - <br /> --------•-------=-------- ------------------_-- ,: Phone ------- <br /> I.. •:. <br /> ��� -------------------=---------------•--- <br /> Contractor's Name---- -------•-------------------=----- I< Motel Other C1Installation will serve: (Residence � Apartment House ElCommercial; ❑ Trailer Court ❑ <br /> = 1 - Lot size -►3"100------------ <br /> Number of living uni}s ." "_ Number of bedrooms "_ Number of baths - ; <br /> / tl tsi✓ G- <br /> Water Supply: Public system ❑. ..C6'mmunity system Ll --Private0 Depth to Water Table `----- ft. `G <br /> Character of soil to a depth'"of 3 feet: Sand C] Gravel n Sandy Loam [ICkay Loam ❑ Clay [I Adobs, Hardpan [I <br /> No New Construction: Yes J� No <br /> Previous Application Made:' Yes ❑ r - <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ° r <br /> (No septic tankfor cesspool permitted if public sewerriis available within X200 feet.) _.. „ <br /> - '. �. ,. ~:-r`.' ' -. ------ <br /> -weMat rias <br /> Septic Tank: Distance from nearestll- <br /> _� ___Distance from foundation <br /> .v .� <br /> 'No.of compartments'_ Size_ _ - = ---L#quid depth ------. ..Capacity..----� �� <br /> �. . .t..,,., 1. = � / _"-__._.Distance to nearest lot line------ <br /> 'Di <br /> __.__..__".""-. <br /> Jr <br /> r( s <br /> Dis oral Field: Distance from nearest well-__. 'Distance from foundation O Width of trench__-___ ------------------- <br /> C <br /> " --.-= --- ---- <br /> -- _ -----Length of each line___•-""- .- --- .r <br /> �Number of lines� - <br /> Depth of filter material----------1$ ----Tota{ length----------------------z d <br /> Type of filter material_____ _ <br /> p Mance:from foundation____________________Distance to nearest lot line-___._�___._____ 6 <br /> r. <br /> See a e. Pit'" <br /> Neu#mbee of to nitar�strwel�------,Linin-------- <br /> material--�----- --- --�- ---Size:'Diameter--:•--------�--------.Depth"-------------------- - <br /> ❑ gning material--------------------------------------- <br /> nCesspool. ,, _. Distance from nearest well____'____ ____ Distace frorri foundation € " Liquid Capacifiy__"______ ________________gals. <br /> . ------------- <br /> ❑ Size: Diameter- ----,--- -- - Depth --- ----- <br /> c t --- cebuilding ----- <br /> Distance from nearest well 7-7- ___ -- ----- <br /> Distance frons nearest <br /> Privy: - = -- �- ------- <br /> Privy: <br /> ren,-'�y..r <br /> ❑ ''Distance to nearest lot line'_"y" "----- -- -------- <br /> - <br /> •---- ,meq <br /> ik - ----------------------------------- �s` <br /> Remodeling and/or repairing (describes ;. ---------:-; <br /> #-- -------=-=------•---------- -------- <br /> ------------- -------------------- -------------------- <br /> --- = <br /> ____________--------------------- ---_ _k_-______-.____._.._:._.____.._.._.___-.__.______. i .. <br /> y � <br /> I hereby certify that I have prepared this application and that the work will be doneein accordance with San Joaquin County <br /> 1 ordinances, State laws; and rules and regulations of the San Joaquin.Local Health District. ) v <br /> ---------------------(Owner and/or <br /> Contractor] <br /> (Signed)-- - <br /> _ <br /> 4 <br /> 7we <br /> (Title) <br /> - <br /> ?V <br /> (Plot plan, showing size of lot, Iota pion of system in rela son t , buildings, etc., can be placed on reverse side]. <br /> -# I FOR DEPARTMENT USE ONLY : I <br /> DATE -- -- <br /> ----- <br /> --- ------• - <br /> - ---- -- --- <br /> APPLICATION ACCEPTED BY--.-'-' DATE =- ----- -- -- <br /> REVIEWEDBy----------`------------ ------------------ -- ------------ . <br /> n. <br /> .. <br /> ----- _ DA E --------- <br /> BUILDING PERMIT ISSUED % ._ ,� ----------f <br /> �A <br /> Alterations and/or recommendations:______ ". «. < : - <br /> --- <br /> -- - <br /> "'� •+ T' <br /> ------ <br /> ---------- ---------- <br /> ---- ------ --- --------------- <br /> ' .} __.____ moi.!__-____.___. <br /> ON BY — --- .. _ Date- _ ---------------- --- <br /> FINAL iNSPECTI "'" -------=`-----•-- ---•----------•----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Oak Street 132 Sycamore Street 814 North "G" Street <br /> ;po Wast <br /> 13o South American S#ree# Manteca, oreSCalifornia Tracy, California <br /> Stockton, California Lodi, California <br /> re-9-2M Revised W-2100 <br />