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FOR OFFICE 0SE: V Or - / --- ----- ---- ------------ --- APPLICATION FOR SANITATION PERMIT Permit No. _12._- ----- ------------------------------------ .12._------------------------------------------ ----- ---- (Complete in Duplicate) Data Issued ----------------- --- -------- ----- ---- pp _ _ -- -- -.- t This Permit Expires l Year From Date Issued Application is hereby made to the Sats Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance.with County Ordinance No. 549. f JOB ADDRESS AN LOCATION--- .- :.�?1.Z1✓ , -_ �le_.9.A deK _--__ � Phone ----------------------------------- --- ------------------- -- -------------- ----- Owner's Name.___ -..-L__ ---- ' Address 1-4 s Ult4_y ---jgAV— .G4'------- �[ ................................ =�- .. �t Contractor's Name___a2 „ - - --- Motel Other � Installation will serve: Residence 54 Apartment House ❑ Commercial ❑ Trader Court ❑ ❑ f 3_._ Number of baths Lot size ----- �� __ ------.-------------- Number of living units: _ __-- Number of bedrooms T Water Supply: Public system ❑ Community s em [ Private .[Depth fo Water Table - ft Hardpan Adobe ❑ ❑ Character of soil to a depth of 3 feet Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ VA:.Yes. t4!0-0Previous Application Made (If yes date________.,_...: },,No New Construtiorl:_Y�s, o.❑s -:fH�• - -TY.PE.,QF,INSTALLATION AND�SPECIFICATIONS - - z (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-.- U.-.-Distance from foundation_-.___lV----_.Matenal ---L_-�lal_ i ='6------- Li Liquid de th-_... -.--$----- --.Capacity_-�� ------- No. of compartments------�------------�=-Size---r��=�x-•� - q R Disposal Field: Distance from nearest well --Distance from foundation__..L-O---------Distance to,nearest lot line___ ----------- Disposal ______ Number of fines,k_________- _----.Length of each line__.____ ---- jam--- -----Width of trench...__....2--------- ---------------- Number length-.-.--------- ---5�----------•----- , Y..—..Type-of-filter-material-_�Q C =,----Depth of filter material..---- ------- -- I Seepage Pit: Distance'°'to nearest well_______________-------Distance from foundation-------------------.Distance to nearest lot. ine._._____.._-...- i - Lining material-- ---------------•--- Size: Diameter------------------ p --.Dept - .------------------- ❑ Number of pits I Cesspool: Distance from nearest well .......... ...Distance from foundation----------------- - Lining material--------..__.______._-----------ads. ❑ Size: Diameter- -- --------- ----- ----- -------- Depth---------- ------ -- ------ ------- -----..Liquid Capacity--------------------------•9 Privy: Distance from nearest well--------------------- --------- ----- --:-----Distance from nearest building_____-_.-.------------ ----- --- .--- ❑ Distance to nearest lot line--------- - - -------------- -- ----------• -------------------- ---- ------------- - ------ - --------Distance OR Remodeling and/or repairing (describe:---------�� Tj /Z'1_._.�.� _� I_��r17----/C -- V -.9rSdL --- ------------------ •---------------------------- --`----------------- ----------�LSPp i _Ir... CdAVI-- -`- :-------- -� ---------------- --------------- -------Coon I hereby certify th'a+'til have prepared-tlli's application and that the work will be done in accordance with San Joaquin County ` Y Y ordinances, State laws, and.rules and regulations of the San Joaquin Local HealthDistrict. = (Owner and/or-Contra ned =---- y- - -- - - {.Si g ). _j(Title) _ ------ ---- ------ ----., - ) (Tl BY=-------------------` . "i k (Piot plan, showing size`64- lot, to a �n of s stem in relation to wells, buildings, etc., ►a� be placed d on reverse side). "'r — —FOR"DEPA-RT-MENT--USE-ONl: ' ' Q ---- DATE—1—:77.7---b - APPLICATION ACCEPTED BY---- ' >`�� ------ - -----------;- -:-------------------- - REVIEWED BY ------------------------------------------------ "I-A .'"". :-_ —LL= _ ,.:- ._ =--_--- - DATE ... ..f r T...� = - DATE-------------------------------------------- ---------------- ------------------------------•- -- BUILDING PERMIT ISSUED_ _ .-.----------------- Aiterations and/or recommendations---------------- - ---- -- -------- - ----- ------------------ -------------------------------- -- ------- -------------------- ------------- -------- -------- ---------------- ---------- -- ------------------------ - - --------------------------..... `� ` _ _ _ t- -- --------- ---- ---------- --------- --- F , / FINAL INSPECTI - - ---- - ..• Date-- -- -----�� --r---- �-�� "------------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 west Oak street 124 Sycamore Street 1 205 West 9111%Street Stockton,California Lodi, California Manteca,California Tracy,California l EM.9 2M 1.67 Vanguard Press