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OR OFFICE SE „ t'`, a.,. .: . . Permit No. _.. --- L`l3 FOR' SANITATION'PERMIT ` ------..L}30-------------- APPLICATION / (Complete in Duplicate) Date Issued Y ------------------------------------------ - -------- - This Permit Ex ires l Year From Date Issued �l_dw-0� ------------------------ ---------- Joaquinp rein described. Applicafiion-is hereby made to the aSan ce with Loco[ He atnce'NoCt 49_for a permit to construct and instal!the work he This application-is made in_.compll"a �1 / --------------- ------- -------- '-----•------ ------------ __ e�F_ _ ---- OB ADDRESS A LOCATI Phone_. Owner's Name_{_ - - - --••------------ Address----- r Phone----------------------------------- ----�;------ ------- ------------------------------,.� = , Contractor's Name--------------------------•- � Motel Other Commercial ❑ Trd-+ler.Court ❑ ❑ i Installation will serve: Residence Apartment.Ho use ❑ ?—Number of baths.__ Lot`size __ `-/�-- Number of living units:._/---..Number of bedrooms --N to Depth Jo-Water Tablet �� ft. r Water Supply: Public system.❑ Community system ❑ A 4� t: Sand Gravel ❑ Sandy Loam ❑ Ciay Loam ❑ Clay ❑ AdobexJ Hardpan ❑ Character of soil to a depth of 3 fee ❑ VA: Yes ElNo Elk Previous Application Made: (if yes,date-______________ __ �1 No ❑ New Construction: Yes ❑ No FHA TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public'sewer is available within 200 feet.) *- , anI Distance fro arfime is well SDiBance from foundatiLquid depth _Material_-------Capacity___________ __-- f No. of comp ce to nearest lot line____ --- !___Distance from foundation__ Ll_------Distan isposaField: Distance from nearest well - Length of each line____ Width of trench.__. -------------1--- Number of lines_______.____ ------ -- --;- De--Depth of filter.material___.___ _ Total length-------------------- t .Type.of filter ma}er�al__`��_�_ _ _ - � P /� Dista m f undation----k,0 •--.Di-stt`nce�to nearest lot line----------------- Seepage Pit: Distance to nearest well_ — - E, ,i Number of pits----- -------------Lining material-- - ""Size.; Diameter_--- --- - Depth __1-------- n r i1. d ning materi Distance.from:nearest well--------------_Di to ce f�m foundation-�- �`_L liquid Capacity___---------------- Cesspool: , ❑ Size: Diameter p s 3 t ------------------------------------ r ; -_--__Distance.from nearest.building__ ! Pnv Distance fromnearest well-.-.r ; ------------- --- y: ` ----= ' ❑ Distance to nearest lot line____.____'______--------- ----- ! E ' ---------------•: odeling and/or repairing (de�cribe)--------------------- ---------------------------------------------------------- Remt .M a f 1 -------------•----•-------•------------------------ - ---- *---------- --•- ---•------------------ ----------- ------ ---------- x. i 1 hereb cerci y that I have preparedulais application the San Joaquin hLocalkHealltheD.i}dc}n accordance with San Joaquin County r ordinancesf S ate Ls, and r es an g i P - _[Owner and/or Contractor G Lei __ _________---------- , __ ___ __ Si ned i - T ---- --------------- ---- ------=---- By=------------ - --------- (Plot plan, showing size of lot, Iota ion of system in relation to ells,'buildings, etc.,-can be laced on reverse side). FOR DEPARTMENT USE ONLY ------------ = - -- DATE-----------------��- -`------�------- ----------------------------------- APPLICATION -- - 74 = i APPLICATION ACCEPTI D BY_------•----------- R j � DATE----------------------- - - r REVIEWED BY ----------- DATE BUILDING PERMIT ISSUED------=-------------------------------'------- -: - _ .. ! . Alteration and/or recommendations: f - 9 ----- c'-" ` --------------6 — Y-� -- ____ { -------------------------------------------- - ---------------------------- e ---------- ----------------------- ----- -------------- - -- -- ----------- if� � � -- w+w..rSSR4s..•i.a+...�+r� - .�'.`-'. _ a.a...�ti � •------- i'} r ---- Date--- --�d-`r --��- --------- - ------ FINAL INSPECTION BY:y------ ---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselion Avo. 30o West Oak Street 124 Sycamore street 205 West 9th Street i r Manteca,California Tracy,California Stockton,California Lodi,California ES 9 REVISED B-59 3M 3^'63 F.P.CD.