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FOR OFFICE USE: No. Permit P ----------- ---------- ------- ------------------- �.J�-l--=--`3��• i APPLICATION FOR SANITATION PERMITf - ----------- ------ ------ -------------- Com Tete-in Duplicate){ p P } Data Issued --"-=�--6�- ' --- --------------- ------ i This Permit Expires 1 Year From Date issued ' Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work�escribed.- r This application is made in compliance with County Ordinance No. , 49. � ------------------- x/ JOB ADDRESS AND OC l _- --- .. ..eve--l? ------� Owners Name__.."- i s57 ��'!�/. - r� --- Phone I Address----------7�0jr-------- 1 `� �� i✓ ---- --------- ------ ------- one -- Ph - Contractor's Name--------- _- Motel Other Installation will serve: Residence ❑ Apartment House.❑--wCommercial-❑ -E] ❑ ❑ F t ,t _ � size � , - _ _ - ------------- Number of living units: ".- Number of bedrooms _ Nuialbe4 of baths_.--____ of . --------------- Water Supply: Public system ❑ Communist t system ❑ Private Depth to WateriTable ft yl Y '` i `iIt e andy Loami� LClay Adobe Hardpan F1l Character of soil to a depth of 3 feet- Sand I] Gravel [ISRlay oaY ❑ No �— i FNo E]FHA/VA: Yes Previous Application Made: {Byes,date_--_..._-� -.. } No 'New .Consru +,r ction: Yes ti f TYPE OF INSTALLATION AND,SPECIFICATIONS: , t (No septic tank or cesspool+perMitted ifl public sewer is available within 200 feet: I i ;% zt _ Material.---- --- ---- ----------------------- ---- Septic Tank: Distance from nearest well_________________Distance from foundation____..-_---- ___-- i l S�t4 p Liquid depthCapacity No of com artrrian.ts---------------�----- ----Size------•------=---- � // Distance from foundation.- _----- Distance to nearest lot line/ �-- Disposal Fields Distance from nearer 'well_ ( --- �' ��-W;dth of trenc�l� , Numbe. af lines --__` "I :---- -Length of each line_ __-- � `� � v ' %"-' Depth of filter material. Total length-- --- .-----------• 4V" _F4Type of` ilte�r_m5ten p c eepage Pit: Distance to nearest we1L -..{-^Distance from foundation_ ----------------_.Dista to nearest lot lin _-. �} Linin material_/-QSize: Diameter��-_---.-- P hA °fit ------ Number of pits-__ s --- --1 - 9 r , ing material esspool: Distance from nearest well -_____.�_.-._-Distarlc e from foundation --------- ------ �Liquid Capacity_----._.__-___-""---"""- --"9als. ❑ Size: Diameter- '---------- -- ----- .epth--------------------- ------------------ q Distance from nearest well ,ta,_ -" ---------Distance from nearest building---------------------------------- ------ Privy: 4ti�-. ❑ Distance tonearer# lot line- -" - - � ' - i/�/_jam#+(! - - ------ -----'-----.__.___.-..---------'----------------------------.--__ Remodeling and/or repairing [de5cribey------------ --- i - ---- ----------------------- ------ ----- } ----- ----------------- ---- ---------------------------------------•---- ---------------------------------------------------------------------------------------------------------- s - ----------- ,--- ---------------------------------------- --------- ---------------------------------------- 1 "-� I herebyAcertify.that I have prepared this application and that.the work will be done in accordance-with San Joaquin County (ordinances, State laws, and rule and regulations of he San Joaquin Loc I Health District. c �,. fT t . (O+rrrr Contractor} R �f� _-___ __ ____ _.._- Si ned ( 9 } ;.;; i (Title).- By: -------------- "d) --------- ( } , size of lot, location" " " (Plot plan, showing of syste re atian to wells, buildings, etc., c be plated on reverse side). V:-, r, t { FOR DEPARTMENT USE ONLY '' ' V..• t } - a APPL w _ ---'� DATE_ ' ------------------------- +� t i ICATION ACCEPTED BY. / - "" REVIEWED BY-----*------------------ --------- ------- -------- --------------- Fc��/z�n�. DATE -.. /T� -----�1�- t BUILDING PERMIT ISSUED________ ________ - �" "" , - ---- i Alterations and/or recommend ations:--------------.----_.----p -------- - -------------------------"--• ----- / - ---------�i------- - i ---- ------- ------------ ------- --- ---------- - - - FINAL INSPECTION BY:-.-. -M---1'�=�'�' Date .......... ------------------------ t f SAN JOAQUIN LOCAL HEALTH.DISTRICT y yy 1601 E.Hazelton Ave. 51 306 West Oak sfree! 124 Syca ore Slreef ;o, 206 West 911r Slree! ca,. Monte California N. Trdcy,California LodiCalifornia Slocklon,California � _ E.H.9 2M 1.67 vanguard Press