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Permit No. ��-7-Q-�r•- <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date Issued _111114.4 <br /> 4 <br /> 111114.d4 <br /> This Permit Ex fires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. <br /> 1r 549. <br /> ------- <br /> ATION.___JOB ADDRESS AND _ Phone_------� 2.0 <br /> -------------- <br /> ----------------- <br /> Owner's Name----------'---- -------------------------- <br /> Address_.. `' one <br /> Contractor's Name------- Motel ❑ Other ❑ <br /> Installation will serve: Residence Apartment House El Commercial ❑ Trailer Court [_1 / <br /> --,1 - x fdumber of baths _�"-- Lot size --------- <br /> .. <br /> Number of living units: _/___ Number of bedrooms __ ___ <br /> Water Supply: Public systemCommunit is stem ❑ Private ❑ Depth to Water Table _-_____ ft. <br /> PP Y: Y Y <br /> Sand L ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Yoam No FHA/VA: Yes E] No ❑ <br /> Previous Application Made: Yes ❑ No El New Construction: Yes ❑ ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ,�?(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> / ptic T Distance from nearest well______ Distance from foundation__________________.Material-____-.__-___-_._-..__--__.-___.-__-____-__.____. <br /> I Distance <br /> of coram nearest ell-----------------Size-------•------------------------Liquid depth__.--------- -------------Capacity--.---------------- <br /> tments <br /> is osa Fi Distance from nearest well_________________Distance from foundation_.------------------Distance to nearest lot line____-___-____.___ p ' <br /> Number of lines-----------------------=----------Length of each line-------------------- -Width n trench----------------------------------- <br /> Number <br /> -------------_------- .� <br /> --_De Depth of filter material----------------------Total length________--------•---• <br /> Type of filter material-------------------------- p _ r <br /> I� r o _ Depth--c�S�- <br /> Seepage Pit: Distance to nearest well-. IUI!K/----Distance from founds`Z�nDimete�__ Distance to nearest lot line._____..:__.___. <br /> 1 Linin material-__.__.___ <br /> Number of pits---- --------- 9 } <br /> Cesspool: Distance from nearest weV!_____. -.-Distance from foundation__-________________Lining material__-_.___--_-___--_._.___----g <br /> _Li Liquid Capacitygals. / <br /> ❑ De th---------------------------- 9 ; <br /> Size: Diameter-- ----------------- --- ------------ p . <br /> Privy: Distance from nearest well"------------------------- <br /> Distance from nearest building------------------------------ ----------- <br /> ---------------------------------------------- <br /> ---------- <br /> Distance to nearest lot line--------------------- - <br /> ----------------------- -------------------- <br /> ------------------------- <br /> ---------------------------- <br /> I ---------- <br /> Remodeling and/or repairing (describe):-- ---------------- ---------------- -------- ----- - ------------•-------."----_-- ----------------------- <br /> { --- -- ---- <br /> - --------- . - ____ <br /> 4 <br /> -------------------------------_-_--..-----__-_-----_"-----_---_--------- L_•_ _._ -_---_ --_-------------I ------------ ------- --------------- '.. --------------------------.---------- <br /> -------- ---------------------- <br /> --- <br /> --- <br /> --- <br /> ----- <br /> -------- <br /> ! h--ereby -------certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta ws, and rules and regulations of the San Joaquin Local Heah District. <br /> Lo: <br /> -----i---------=------------------ Qa`rse�� 1°r Contractor) <br /> (Sign -- <br /> ----- (Title) <br /> ------------------- ----------------------------------------- --- <br /> ------- -------------- <br /> $Y <br /> tPlot plan, showing size of lot, location of system in relation-1 o lls, building etc., can be placed on reverse side). <br /> FOR DEP TMENT USE ONLY <br /> DATE-------- <br /> APPLICATION ACCEPTED BY'_ T -----` <br /> :.___ . �- - - <br /> -- <br /> 2J <br /> REVIEWED BY----------------------------------------------------------------------------- ... <br /> ----- <br /> - -------------------------- <br /> ----=----------------- --- DATE----- -------------------"----------—---------- <br /> -­-------- <br /> ---------------- --------• DATE------ •-------------------------------------------------------------------- <br /> BUILDING PERMIT ISSUED -------------------- <br /> - y " <br /> --------------- <br /> -- ------------------------------------ <br /> Al+eratians and/or recommendations:-___"_..__.._f_,""__-- -- _ __ _ _ ---------------------- <br /> ---------------- -- <br /> -----------2---------------------------------------------------------- <br /> ----------- ---- <br /> ---------------------- <br /> --------------------------------- <br /> -- - ---------------------------------------------- <br /> - '----�------• - - <br /> - --------------------------`--------- <br /> FINAL INSPECTION BY:....._-"____..._-"-"-- <br /> ------ -------------------- Date--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814;North "C" Street <br /> 13o South American Street Trac California <br /> Stockton, California <br /> Lodi, California Manteca, California y' <br /> ES-9-2M - Revised 8-'59 F.P.CO. <br />