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PERMIT Permit No. -.72-1-6- Y �7 APPLICATION FOR SANITATION I (Complete in Duplicate) Date Issued ---------- \tX' )I Health District for a permit to construct and install the work herein described. n is hereby made to the San' Joaquin Local Application y Ordinance No 549. 3PI-anc with Count, I application,is made in co I - --------------_- Ii 0.1�1 This app ----------(Wfe,�_C ,/ 03 LOCATION--- Ph -7 o n 520Y(19 6 JOB ADDRESS AND -------- ----------- ------------------ --- ---------------- IV-------------I--------------------I------------ Name---C X_rlb------1_'117 ---- --- C Owner's --------------- A Address ---------- _r-------------------------- -------------- Contractor's Name______.__. C Trailer Court E3 Motel ❑Il Other C] rnmercial e__>< --S' Residence 64/Apartment House Ej- - .0----------- ill serve: a e-------- -- Installation wi I/ --I-- Lot size Number of livin I g u i.nits'. --.I---- Number of bedrooms - ----- Number of bath to Wafer Table -4/0-ft. s mmunity system 0 Private 0 Depth Xfardpan 0 Water Supply: Public ystem ��Cl ' ravel El Sandy Loam E3 Clay Loam ❑ Clay C] Adobe Character of soil to a depth of 3 feet: Sand Yes [] No El r is available Previous Application,.Made: Yes F1, No.��Nw Consfruction',Yes E] . No D- IFHA/VA: TYPE OF INSTALLATION AND SPECIFICATIONS- eirmitted if publicsewe within 200 feet.1 C1� (No septic tank or'cesspool P Material------------------------------------------------- .__DiJ1nce from foundation---:--------------- Dis'tance from nearest well________ size--------------------------------Uquid depth-------------------------CaPac'fy----------------- ep� No. of compartments__--__-------- fion---I-, "* -----/A----- Distance to nearest lot line q.-- • Distance from founda th of trench.___42 ---------------- Distance from nearest well-Am, -----wid Disposal Field: �s 11 ---------- Length of each line-- __,0.. `"`----.Width . length_ ----------------------- Number of line ----- ------ ---- lenc -� nearest lot line---- I&- Jj Depth of filter material Type of'filter maferial--s-Tu Distance from foundation 0---------:Disfance to n If --------- J*------DeptA16_01.---------------------- �rest well_RtobLe 7-e-meter--3.5----- age Distance to nearest i-RaCk-----Size: Seep t---------------Lining materlia _ -I--. C� Number of pits-- ----Lining material --------------------- Distance from' nearest-we4l------------------Distance from foundation Liquid Capacity----------------------------qa s. Cesspool. ---------------De❑ pth----------------------------------------------------- Size: Diameter----------------- -------- - -Di5fance from nearest building------------:----------------------------- C�3 rom nearest well------------------------------------------------ - --------------------------------- ---------------------I---------------- Distance'f' ------------------------ 4 ----------------- ----- Privy'. nearer} lot �ine-------------------------- 0 - - Distance to n ----------------- Remodeling and/or .repairing (describe):------------------------------------------------------------- ----------i------------------------------------------------------------- -------------------------------------•- -------------------------------- - --------------1--------------------------------------- - --------------------- --------- --------------------7--- -------------------------------------------------------------- --------- - -------------------------I---------------------- --------------I----------------------------------------- -----------------------------------------I--------------- ----I--------------------------------------------------------- ----------- with San Joaquin County---------------------------- I that work will be done in accordance w ----- ------------------------- prepared this application and 7 I hereby.certify fhaf1 have S a I egulations f t San aquin Local Health District. ordinances, S ws, and rule C Contractor) ---------------------- ------ ----------- - ---- --- ---- -------- ------ ----------------- (S' ned)....-------r_�Vux.,,u (Title)_ ( '9 --- - -- ------------ ------------- -1--- -----(Ti-p By:--------------------------------------atio-n of sYst in -rela 0 tow uildings fc., can be placed on reverse side). (plot plan, showing size of lot. location • DEPARTMENT USE ONLY . I DATE7S:- -------------------- ---------------------------------------------------- tp,_- = REVIEWED ACCEPTED By - --- ----------------------------------- --- DATE---,---.--------------------�r - ----------------------------------------------------------------------- ---------- REVIEWED By------------------------------- ----- ---- ------ ------------------- DATE. *n--------------------------------------- ------------------------------ -------------------- BUILDING PERMIT ISSUED------------------------------- reC0rpjnncIatiqn,._y x ---1.1�& -------- -- -- -_ 1terations and o ------------------I-------------- q1 A, ------ ------------------------- . ........... .....!�----------------------- --- ---5- ---- ------ ------- - ............ ......... -------I------------------------------------------------ ----------------------------I-------------------------- ------------------------------- ------- ------------------------------------------------------------ -------------------------------------------------- ----I __1----------------------------- --------------------------------------------------------- -----I------------ ---------------------------- ------------------------------------------------------------------------ do Date_-- ------------------------- - - ---------- 7, FINAL INSPECTION BY.---'-.- --- ISTRICT --- I- SAN JOAQUIN LOCAL HEALTH D V 132 Sycamore Street 814 North "C" Street 300 West Oak Street Tracy, California 130 South American Street Lodi, California Manteca, California Stockton, California Revised 1.57 F.P-CO-