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FOR'btFi1C­E USE: "Alf <br /> ' 0, <br /> ....... Permit No. <br /> -------------------- --------------- --- --------- - APPLICATION FOR SANITATION PERMIT <br /> ----------- ------- --------------- ------------------- <br /> ..... . (Complete in Duplicate) Date Issued1J-=f •- -- <br /> - <br /> --------- <br /> ---------------------------- ----------------- --------- This Perm Year From Date Issued <br /> --------- ----------------- ------- -------- ---- <br /> Application is hereby Made to the San Joaquin Local Health District for a permit to co <br /> This application is made in compliance with County Ordinance No 549 <br /> I _Z <br /> ---------------------------------------------- <br /> JOB ADDRESS'AND LOCATION...__15__,�'--- -------- ------- -------- <br /> Phone ------ -Name_ _V------- <br /> -,a;LIK <br /> 617 <br /> A A �'X <br /> Addres ...... <br /> ---------- Phone_.0xr _4 <br /> Contractor's <br /> Motel Other E <br /> Installation will serve: Residence Apartment House [ Commercial Eraer [ [ <br /> -------- <br /> size <br /> Number of living units: _1-____ Number of bedrooms Y Number of baths Lot <br /> Community system K Private R Depth to Water Table -------- ft. <br /> Water Supply: Public system El Sandy Loam k Clay Loam' ❑ Clay E] Adobe[] Hardpan [I <br /> Character of soil to a depth of 3 fee+: Sand ❑ Gravel 0 New Construction Yes N o E] F H A,-W,-. Yes )C N o El <br /> Previous Application Made: (If yes,date- No <br /> -TYPE:OF INSTALLATION ANDrSkClFiC:1�00NS' <br /> (No septic tank or.cesspool permitted if public sewer is available within 200 feet.,—tr <br /> . ell 6_0__Distance f rom foyda <br /> Septic Tank: Distance from nearest y <br /> '4�11_ e _"X.4?1 �2_3__Tiq,iid clepth_-."�M- ---------Capaclty.Ave_,�i <br /> Size _ - - <br /> No. of compar. - ------ <br /> K, foundation_. o nearest or 4 <br /> --------Distance t t I t I'ne-- <br /> Disposal Field: Distance from rinest welli3w------Distance from founda .1 e <br /> of trench__ -------------------- <br /> Length of each line - ---- e <br /> Number of line; - ----- ter 4f-_ -length-----------4?—----------------- <br /> Depth of filter rial----417"__ ----Total <br /> Type of filter materi ;�_—_.Distance m foundation---------------- Distance to nearest lot line_-______.._...- <br /> Seepage Pit: Distance to nearest <br /> Distance <br /> Depth <br /> n <br /> c <br /> 0 <br /> of <br /> f <br /> each <br /> m <br /> c <br /> r <br /> f <br /> I <br /> 0 <br /> in <br /> u <br /> e <br /> a <br /> nclat,-on__/ <br /> ,6 <br /> e <br /> Size: <br /> Diameter_ <br /> efer- <br /> Number of pits---------------------Lini�ng material ------------------- --Size: Diameter--I---------------------Depth--------------------------------- <br /> El .�f n_e f rom fou'cla t-o- - ----- ------ - Lining material___._..__---------------------------- <br /> Distance from nearest well-----------------Dis, ni�e,.frorn foundation------------------- <br /> Cesspool: h --------- --------------- -----Liquid Capacity_ .------------------------gals- <br /> ----------------------------------------- <br /> Size: Diameter--------------------- --------- ----De h_ <br /> El f <br /> Distance from nearest well----------------------------- -----------------Distance from nearest building------------------------------------------ <br /> Privy: ...... -----------------Distance <br /> - --------------- -j❑ ------------------=----- - <br /> '�of line_____.__._----------------- <br /> , �7------ -------- -------------------- <br /> Distance to nearest20— — S. —f5 <br /> 4 4 <br /> f <br /> ----------- <br /> --------------- ---------------------I---------------------------------------------------------------- <br /> Remodeling and/or repairing describe ` ---------------------------------------I----------------- ----- <br /> .- .. . V 11 j------------------------ <br /> -1---------------- <br /> ------------------------------------------------------------------ ------- <br /> ------------ --------------------------------------- <br /> .I ---------------------- <br /> ------------------- - ---------------------------------- <br /> --------------------------------------------------------------------------------------------------;�------:--i -------------- <br /> I <br /> --------- --------------- ------ <br /> ---------- ------------------- -----------------------------------------------------------------4------------0------------------------------------------------- ----------------------------- ------------------------- <br /> i�d that the work will be done in accordance with San Joaquin County <br /> I hereby certify that,Wve­ptepared Aiscapplicaflon an <br /> ordinances, State ji,&hales and re?ula tions of'fhe-'San Joaquin Local Health District. <br /> "1 7 <br /> x. <br /> r Contractor) <br /> -- ------ ---- - <br /> 2915 E.Miner Ave., - H0.6-3841 --- ------------ -------(Title----------------------------------------- __A------- <br /> By---------------------%------------------------------------------------------------------------ placed on reverse side). <br /> (Plot plan, showing size of lot, locafi&n 'of system" 'in relation to 15ts?, bui'ldings, et can be <br /> FOR DEPARTMENT USE ONLY <br /> 4S <br /> APPLICATION ACCEPTED BY------ --- ------ ---------- --------------------- <br /> -lz�----------------------- DATE----- 7 ---------------- <br /> REVIEWED BY- -------------------------------- -------------------------------------------- - <br /> ------------------------ <br /> --- --------- ------DATE---------------------------------------------------------- <br /> 11_1� j DATA.----------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------- . �_r_1 I------------------------------------------------------------ <br /> Alterations and/or recommendations________________________-------------------------------------------- --- <br /> I } - ---------------------------------------------------------------••--------------------.. <br /> ---------------------------- -------------- ---------- -------------------------- -------- <br /> -----------------------------------­ . : �­ - ------------------------------------------- <br /> ------------------- ------ -------- ---------- -------------------------------------------------- <br /> ----------------------------_-------------- ------------------------- <br /> 4 1.0 ---------------------------- ----------------------------- ......... ------- <br /> ---------- ----------------------------------------- -------I --- ---- --- --------------- ------------------- ---- ---- <br /> --------------------- ----------- -- ------------- --- ------------ ... ...... ----- <br /> -----D--a--t--e-----w--------------------------- --------------------------------------------------------------------------------------- <br /> - <br /> FINAL INSP. . . . ... -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street <br /> Stockton,calif.ornia Lodi,California Manteca,California Tracy,California <br /> F.P.00. <br />