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FOR OFFI(�,USE.' Permit No. 1.3 14 'r <br /> ..................... <br /> —APPLICATION FOR SANITATION PERMIT <br /> . .......... . . ..... Date lssuecl .K.�-(3- <br /> ............................. .............. =1j* 1nDuplicate) ............... <br /> ........I--- This Permit Year From Date issued <br /> a permit I nstruct and 11 thew herein desKibed. <br /> Application is hereby made to the San Joaquin Local Health District for a 0 <br /> ;This application is made in compliance with County Ordinance No. 549. 2:XA, p <br /> Z7 <br /> JOB ADDRESS AND LOCA tl <br /> rm,t'a 0 <br /> Owner's Name.... <br /> 4... ....... <br /> .................. Phone.......................... <br /> Address........ ....... ...... ........ .................. ............... <br /> % <br /> Contractor's No Z�.................... . -- .. - . .................... Motel Cj Other Lj <br /> Installation will some: Residence E?-Aparlmont House 0 Commercial E] Trailer Court 0 <br /> Number of living units: ./.. Number of bedrooms 53.. Number of both,/.!... Lot size "'p <br /> Water Supply-.' Public system El Community system 0 Private M4.`pth to Water Table AdobeZ-O.—rdpan <br /> 3 <br /> Character of soil to a depth of 3 feet: Sand C 0 <br /> Gravel Sandy Clay.LoamE3 ClaYCI <br /> C] FHA/VA:Yes /rye 0 <br /> Previous Application Made: (If Yes,dote. ... _­1.........I No 0_11"Construction: Ye <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: - <br /> available within �00 feet.) <br /> kn 6 /49 M <br /> (No septic tank or cesspool permitted if PublicsitwOr is cation.... . <br /> Distance from nearest well Jr D;st:?n <br /> _111 fo <br /> Septic Tank: Di Zo 5- _!.....:Ca <br /> - ----Liquid d.r.th.. <br /> No. of comP81+rnenfs...1Z .....li.r.'. . est I t ;nlj �... <br /> Distance from foundation-n-Z <br /> .gr..........Distance to ears <br /> Disposal Field' Distance from nears well. . ....... Width of"richr.- ....... ........ <br /> Length of each line..�� <br /> Number of lines... ............. <br /> r material.-�� <br /> Depth of filt& lisngth.:� <br /> Type of filter material/, <br /> Seepagq,�i f: Distance to nearest well.:../ <br /> Distance f,7n fou9d5 <br /> /4f.P........Distanc,to nearest at mo.. <br /> I;u ....... neatest <br /> .......... <br /> Numba. of .......Lining material.,,,W& Size: D'a ote"'"" <br /> I Lining'material.......... <br /> Distance,t I once from reariiisf well.................Distance from foundation .............. ............._gals.. N, <br /> Cesspool: Liquid Capacity............ <br /> 11 Depth.................................................... <br /> 0 ­ from <br /> rest building................................ <br /> Size: Diameter.... ............................. <br /> or <br /> Privy: <br /> Distance from ncisresf well.. ........................................D;sfance trom!nea <br /> ........... <br /> Distance to nearest lot line................. .......... .................... L...... .......................... <br /> JCa ................................ ......:.......... <br /> Remodelincj�end/or repairing (describe) <br /> ...... .............. <br /> .......................... .. <br /> ........................... ................................................... .................................... <br /> "1 .1 ...................................................................................................................... ................. <br /> ............................... .......................... ........ <br /> ...................................................................this. ....application-. . .. .---a.n.d..t.hat_f-h....work... h Distrtr_.will..b....done... in a a cordance with San Joaquin County <br /> I hereby certify that I have preparedic . <br /> ordinances. State d les and re ulat, ns of tho,San Joaquin Local Healt <br /> r Contractor) <br /> .... .. ...... <br /> ................................................... <br /> BY:------- .. . Is, buildings, etc.. can ba placed on roveme side). <br /> (F;of plan, showing W <br /> size of lot, location of syst n relation to .61 <br /> FOR DEPARTMENT USE ONLY <br /> DATE.AT T ....................... <br /> APPUCANON ACCEPTED ............ DATE...... ....----­------- ................... <br /> ............................... <br /> REViEWEDBY......................... ........ ...... ............................. <br /> BUILDINGPERMIT,ISSUED.............................................................................. ................. DATE............................. - .... ......... <br /> Alterations and/or recommendations:..... ...... .......................................................................................................... <br /> ...................I........................ <br /> ............................. <br /> ...................*................. ...........*........... ........ .............*.... ........*... .................. <br /> ........................................... <br /> .................... <br /> ............1:................................................................................................. ........................................................... <br /> ............................................................................................................................... <br /> ...................... ........ ............................................................... <br /> ..........­.................................................................................... <br /> ................. . .................... <br /> L.a. <br /> Date....._... . -Z!iv ....................................... <br /> INAL \Ic.PECTION BY:... ..................................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Sneei Ira .Yremen Ami 205 W.10 91%3~ <br /> 150 S.W <br /> 300 W,4 O.k <br /> t.dl,Critlf-,M- • Tracy,C.10"M, <br />