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FOR OFFICE USE: ------------------------------------ ------------ APPLICATION FOR SANITATION PERMIT Permit No. ---- --------- ------- -------- (Complete in Duplicate) - - ---------------- ----------------- ---------------- ---------------- - This Permit Ex;S.ires' l Yeatfrom Date Issued Date Issued Application'is,.-liereby made to the San Joaquin Local Health Distridt'for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. '649. MANT_F-C� I :;Z �! � - JOAf------R: ----------- JOB ADDRESS ANOCARIoF--11VIA-X�n-------------------------I-----14-0-ur> -A------2aF-----VNN . _r�_ Owner's Name--------------------CILARM-NCE:----------MA-7,� `R15---- -------------------------------------- ------ Address,...--- --- Phone--------------- ------------------- R,(4---�--T. R A il-4�e K _r=-------- ------j,9109.& ......W-----X%?6E7_M_t__71 WA ----------------------I----------- Phone-----------------------------------I Contractor's Name_-__ ------------- ------------------- ------------------- eMotel 0 Other 0 lnstallation will serve: Residence Apartment House El Commercial ❑ Trailer @as 1 , 0 1� � 7 �'er of living units: __1---- Numberpf 'bedrooms _3� Number of 1, Nur�n baths Lot size -----1 -6-----I- _13-Y ---------------- em ❑ PTi`v`ate'i0/ Community s Depth to Water Table -6--- ft. Water Supply:,, Public system [I Hard Character of soil to a depth of 3 feet:. Sc'snd `-Gravel 0 Sandy Loam 0 Clay Loam [:] Clay 0 Adobe 0 a 'n E] r N ❑ Previous Application Ma2e:Klif yes,-aate------------------ -I NP-��Ne' w Construction: Yes�'2�< E] FHA/VA.. ) es 0 TYPE OF INSTALLATION AND SPECIFICATIONS:,___,� cesspool permitted if,public sewer is.availabl_e_within�200 ie=t.) (No,septic-tank'or�essp k I_ +an --------- Septic T k: _IDistarkfrom nearest well----5__ ____bi, e-from foundafion----/0_..__._.Material------C �D - -.11 - - — J/------------------Capacity..J Z-047 . Na. fe comparfments__,__'_.-��-----------S i 7 e_RX)-19--X--5------Liquid ciep�b---- W?01 : I 1�. , I -i Disposal Fieldy Distancefrom nearest well._50-- 'Disfance from.founclation__7_0--------Distance to nearest lot line Number. of.lines -----------r Length of each -._--_.Width of trench....2-Y.,_._------.;4_-------- Type . .........4--------- Type of filter,material---7?0C_.�:!,,.Depth of filter material-----/ ......Total length--------------420---------------- SeepagOif,`-.& Distance to nearest well -----—-----Distanc*frcim foundation___'A._'-__-_----.Distance to nearest lot line----------------- I r_!%� iI e Dia� meter----------------- -----Depth------------------------------ El ~;''Number of pits------I---------I------Lining maferia ----- ym._7 Cesspool: Distance,fim nearest well-----------------Distance from foundation-----------------...Lining material------------------------------ ,-'0 0 Size: Diameter---s----------f---------------------Dept h--------------------------------------- ...........Liquid Capacity--------------------------•-gals. 4 _�w - - - fis *%Ed I #-) Privy: Distance from —------ 7_--..._Distance from7 nearest buildin;--------------------------------- ------- El bisfance,fo nearest lof-liirrel-J_17 I -1� _+'_ -—----------- ----------------------------I----------------------------------------- - Y, Remodeling and/or repairing (describe),-_.-------- - -------- ------ -----av------- 46f "I y ie ------------------••------------------- ------- -------------------------------------------------------------- ------------------------------------------------------------T--k-R.(D-: -------------------------------------- ----------------------------------------------------------------------------------- --------------------------- ------------------- ------------- —,-;i 7- -------------- ------------------ -------------- ---------------------------------------------F----------- -----------------------------------------I------------------------------------------- t------------------------------------------ I hereby certify that I have prepared this application-andjhif-fhe work will be'done in accordance with San Joaquin County ordinances', State laws, and rules-,and rigulafions of the San Jo64uiri-Local Health District. w e -Api I ' akil-u-i (Signed) -F------40--------- -------------------- ra -----------------(Owner and/or Cont� ctor) --_-------------------------------------- ------------------------- .......;=--—77-77-1- Tifig)---------z!7`77_77�___ _---- - ----- -------- 0 ' %Ir (Plot plan, showing'sizie of.16t, location of system in relations o wells, buildings, etc., can be placed on reverse side). a FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-__-----t---11 ......------------------------------------------------------------- DATE---------4' --------------------------------- REVIEWEDBY----------------- --------------------------------------------------- ---------------I------'------- ----------------------------- DATE------------------------------------------------------------ BU I LDI NG;-PERM IT-ISSUED- DATE----- - ------------------------------ --------- r-------------_--------- Altera"iFon"ra7d/'jr7e'com—me-n 'n"s—" ----------- -------------------------------------------------- -------- - - ----- .- i ------ -C-- ---------------------------------------- Al ------------------------------ --------------- --------- ------------------------------- ---- ---- --------S7 I> 5(F_-n-A 5_7X:7:0� 41a�lq Q1 fwl>�n _r------UN _j_6-------�10V_L ty------_...A�=--_ri -------Tt A -0-----=---------------- -------------------------- FINAL INSPECT BY:-- -- -- - ----------------------- ---------------------------- ----------------9_�--- - --- ------ i--------------------------------------------------- ---- -------------------------------------------- ate------- ---------------------------------------- ------ -- D SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. t 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-'63 F,P.00.