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Permit No. ....... <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date Issued ------ ------- <br /> al Health District for a permit to construct and install the work herrein` described. <br /> Applica;ion is hereby made to the San Joaquin Loc Ordinance No. 549, �&;-A--+ APA-� 9 <br /> This application is made in compliance wil County Ic <br /> Ir q_ f \1 ,j -------------------- <br /> C ION----- ------- -- ---- --------- <br /> S AND f -------------- <br /> -------------------- <br /> Phone <br /> .......... <br /> ....... -------------*----------- <br /> Owner's Name------ ------ ------- A <br /> .. ............ ---------- --- ----------------------------------------------- <br /> uqk�---------- ------ --------------- <br /> Address—------------------- !_ I L----------------------- Phone.-36—�-0-.7 ------- <br /> Contractor's Name________ ----------------------- -- - - -------- ----- motel ❑0 Other El <br /> Installation will serve: Residence n Apartment House' D Commercial 0 Trailer Court 0 <br /> Number of living units: -------- Number of bedrooms -------- Number of baths Lot size —----------------------------------- <br /> Water Supply; Public system [I Co�rnmunity system I Ej Private [j Depth to Water Table -------- if. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam 0 Clay Loam [I Clay 0 Adobe pan 0 <br /> Previous Application Made: Yes 0 No n New Construction: Yes [] No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> septic Distance from foundation-------------------Material------------------------------------------------- <br /> S <br /> c Distance from nearest well -Liquid deoll-------------------------Capacity----------------- <br /> No. of compartments------------- ------------Size_------------------------------ <br /> --Distance from foundation- -Distance to nearest lot line./ ------- <br /> earest well_( .Field: Distance from n (.... -"--Length of each line------- -.Width of trench---ca e <br /> Number of lines--- r material----- -------Total length--.0"-------- ---------------- <br /> e ...Depth of fitter <br /> Type of filter mat r11 U_�__-Distance from foundation-----------_-----Distance to nearest lot line------------------- <br /> Distance to nearest well________________" Size: Diameter---------- ------------.Depth------ -------------------------- <br /> pa, <br /> Number of pjt5.­_7-1__-----.-Lining material------ ---------------�Si -_ Lining material--r--------------------------------- <br /> Cesspool: Distance from nearest well-_____________"__Distance from foundation----------------- I <br /> Size: Diameter------------- ------------------------Depf k----------------------------------------- ----------Liquid Capacity-------------------------- <br /> 0 Distance from nearest building------------------------------ -- <br /> ---------- <br /> -------ga", <br /> ----------- <br /> Privy: Distance from nearest well------------- <br /> ---------------------------------------------------------------------------------------------- -- <br /> Distance to nearest lot line_-___._----------------- <br /> F <br /> ------------- <br /> - -- ------ ------ <br /> anclLgLfiepairing escribe) --------------- <br /> 02_4%�---------------- ---Remodel' ? -4 <br /> ------ ------- ± <br /> -4 <br /> --- ------------- i------ - -- ------------- <br /> ---------- ------ ------------- _--------------------------------------------------------------------------------------------- ------- --------------------- <br /> ------------ ---------------------------------------- ------- <br /> ----------------------------------- <br /> - ------- ----------------------------------- -p-pi-i-c-a.ti-on and that he work- will -be done in accordance with San Joaquin County <br /> I hereby certify that I have prepared this i of +he San Joaquin Local Health District. <br /> ordinance$. State laws, and rules and regulations "Nv 11 1 .- -1. <br /> DAY & NIGHT :- ------tewnev RwAAw Contr6cfar) <br /> ------------------- - - -------- I <br /> (Signed)-_- ------ -------------- <br /> 1206.5 -----------------------P. - <br /> 4 (T ------------ <br /> --------------- rn in relation to 611s, buildings,ings, c <br /> *---- of lot, I§WWr0fCS9kkI6 can be placed on reverse side):1(Plot plan, sho size <br /> FOR DEPARTMENT USE ONLY. <br /> APPLICATION ACCEPTED BY_�. .... "..-_------•---- -------- --------------------------------------- DATe - -------------------------------------------------------- <br /> DDATE" -------------------------------------------------- <br /> REVIEWED BY------------------------------------- .....­----------------- ---- - --------------------------------------------------- ----------- <br /> ---------- DATE------ -------------------------- ----------- <br /> BUILDING PERMIT <br /> -------------------------I-S--S--U---E--D----------------------------------------------------------- ----------­------- ---- --------------------------------------------I----------------------------w---------------------------------------------------- <br /> Alterations and/or recommendations:_-.-___"---------------"-"- - ­- <br /> --M----------------------------------------- <br /> - <br /> --------------------------------- <br /> ------------------------------------------------------- --------------------- ------ ------- --- ----------- ------------------------------------------- ------------------------------------ -------------------- <br /> --------- ----------------- ------------------------------ ---------- ----------------------------------:-------------------- ------ ------------------ <br /> ------------------------------ -------- -------------------------------------------------------------------------- <br /> ------------------------------------- <br /> ------------------------- ---------- -------------------------- -------------------- <br /> -----------------•--------------•---• <br /> -- <br /> FINAL INSPECTION BY:_..-"- __2 - <br /> -----•---•---•--•------- -------- --- ---- -------------- <br /> ---------- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 S7yZ.n,-re Street 814 North "C" Street <br /> 130 South American Street <br /> 300 West Oak Street Ia. -.Tracy. California <br /> manteo California <br /> Sfo(:kfon, California Lodi, California <br /> FS-9-2M 145446 ATWnUD 12— <br />