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le-111--w-r--,FOR OFFICE USE: i Sot <br /> Permit No. <br /> .........­-­­­­...................I----------- APPLICATION FOR-SANITATION PERMIT <br /> ................... <br /> (Complete in Duplicate) Date Issued <br /> .............. ............... This Permit Expires 1-Year From Date Issued <br /> ........... ............ ..........I...... o construct and Install the work herein described. <br /> Application is ereby made to the San Joaquin Local Healfh District for a permit <br /> This applicati n is made in compliance with County Ordinane No..54,9. <br /> .0 ............ ............................ <br /> ---6C ................................ <br /> JOB ADDRESS AND LOCATION... Phoneglf <br /> Owner's Name-._---._.-...... „t..._.. .... ................................. <br /> Address--------------------------------- ----­----- <br /> Phone----------------------------------- <br /> ......................... <br /> Contractor's Name. -------------------------- ..... Motel 0 Other 211"jLVS1t <br /> Residence [] Apartment H;Duse C] Commercial [3 Trailer Court 0 ----------------------- <br /> Installation will serve: I bedrooms I— Number of baths ....LLot size -.. A& <br /> Number of living units: Number of be 10 Water Tab <br /> Water Supply: Public system ❑ Community system El Private g,-I�epth i,--- is <br /> Clay Loam 0 Clay Adobe 0 Hardpan 0 <br /> et: Sand [] Gravel [I Sandy Loam 2� <br /> Character of soil to a depth of 3 fe Yes [!I-'No FHANA: Yes [I NO <br /> Previous Application Made: (if yes,clate..................... No 2�'Now Construction: <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: liable within 200 feet.) <br /> le tank or cesspool 10 ............... <br /> ,pol p�!rnitted if public sewer.is available_(No sepf foundation_._.. ......Material....469.ri�c <br /> Distance from nearest wejl� Distance from fou Capacity---12CrP-- <br /> Septic Tank: of compartments ...... depth--------- ......... <br /> No. W lo i ....... <br /> .17... '• <br /> from foundation..... to nearest Disposal Field: Distance from nearesf well... 4 - ­I... ............. <br /> Number of lines.......... Length of each line.......... C>..........Width of trench <br /> ....................... .*' <br /> Q�..... f filter material......Lf."-......Total length...... <br /> Type of filter i o from foundofion....................Distance to nearest lot line-------------- <br /> Seepage Pit: Distance to nearest well.--.................Distance h--------------------------------- <br /> F71 Number of pits..-----. Lining material.......................Size- Diameter­----­--------------Dept ............... <br /> Cesspool: Distance from nearest well.................Distance from foundation....-...............Lining material...................... <br /> Liquid Capacity............................gals. <br /> Size: Diamefer.......... ---------------------------...Depth------------------ -----------------------•--------•-- -;..�. —- �­­­ �� <br /> 171 -j-.,;.-'. , - Z.. ­ . --Qq - �'- from nearest building... <br /> r,a-� =X,—-�; Distance from nearest well ............................ --------------- <br /> i. Privy- Distance to nearest lot line__._..-----------•------ --------------------------*.........**------------------- <br /> 13 --------------------------------------­---------------------------­---­--­­­................................................. <br /> Remodeling and/or repairing (describe)----------------------------------------------I.................. ............... <br /> ................................ .........................................................­­........ <br /> ...................I................................. ................................................. ........... <br /> .....................I........­..................................... <br /> ......................................................................---------•-..•--•- <br /> ....... .. <br /> ................. ................................ ..............................._..........--qui.................... <br /> .................. ............. .........................................................................................ill..be---done..-"in accordance with San Joan County <br /> application and that the work w <br /> I hereby certify that I have prepared this aPPI <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> {Signed)...--------- .................................................................... <br /> ....­......... ................. .................................. ._...._.{Owner and/or Contractor) <br /> (ritle).................................._....•--.........';........ <br /> rse,sidt):�- <br /> ............... - 'buildings, etc.. can be placed-on reverse h in relation wells, <br /> 'buildings, <br /> 's owing siz <br /> FOR Q ARTMENT USE ONLY <br /> DATE <br /> APPLICATION ACCEPTED B ..... ..... .. ._,._---••---.....__....__--•.............­­............... .......... .......x-5-f-�....... ............ ----------------­' <br /> DATE...­------------------------------------------------------ <br /> REVIEWED BY----- <br /> -----------............... ............ ...-----....._.....---•-•--- ............ ................... DAZE_----------------------------------------------------------- <br /> BUILDING PERMIT ISSUE ------ ......................•---•---............_----•----•-- <br /> •• ....................................................................1-...................................... <br /> Alterations and/or recommen ations:............................... ............................ <br /> ......................... ...................I......I...................................................................... .......................................................................................... <br /> .............I...................................................I. ........................................................I.............................I.......... <br /> ......................................­ <br /> ................­­............................ ........................... ...............­... <br /> ...................................................................... ........................................... ........ ..........................................I....... ....... <br /> ..............................­............................../............................ <br /> ...................... <br /> Date.-....... ................................. <br /> FINAL INSPECTION <br /> SAN - A'- Q- U-1-N L--O--C--AL HEALTH DISTRICT 205 West 9th Street <br /> 1601 E.Kaxelion Ave. 1300 West Oak Street 124 Sycamore Street Tracy,Colifaynic <br /> Lodi,California Manteca,California <br /> Stockton,California <br />