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A <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> 7 Da.fe-Issue 6 cl. ----tq, <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 compfiance with County Ordinance No. 549. <br /> //0-y"'It <br /> ------- -- -- - ----------I----- - <br /> ---- --------- <br /> JOB ADDRESS AND L0CATION____&V__// -------------z--- ----- - <br /> Owner's Name-------------Alor.- --------- ------------------- Phone------------------------------------ <br /> --------------------------------------------:------------------ <br /> ---------------------------------- ------- <br /> ---------- <br /> Address--------------------------- ----- .. .....S <br /> Contractor's Name----------------------- ------ ------ -------- ---------- Phone.51_�, "_Ior_ <br /> Motel El Other F] <br /> Installation will serve: Residence Apartment House El Commercial E] Trailer Court El e <br /> Nur nber of living �pits: ----I Nuiber of bedrooms _3--- Number of baths Lot size ------ --------------- <br /> Water Supply: Public-system 0 Community system El 'Private Depth to Water Table Ap ft. <br /> il to a depth of 34elet: Sand E] Gravel El Sandy Loam [I Clay Loam El 0ay E] Adobe Hardpan F] <br /> Character of so* A <br /> Previous. Application Made: Yes E] No� New Construction: Yes El No FHA/VA: Yes E] No <br /> K <br /> TYPE OF INSTALLATION'AND SPECIF CATIONS: <br /> (No septic tank or cesspool permitted &public sewer is available within 200 feet.) <br /> _t- - � - ___jwi - /0 . Material_ --------------- <br /> Septic Tank: Distance from nearest we�l__ ------Distance from foundation---4_1------------ ---? <br /> No. of. complartmen.ts........;7---------------Size-------47------------------Liquid dep.th------_!�_77o------ Capacity <br /> Dispo5al Field: Dist�nce from nearest weT____YA------Distance from foundafion_____,117/------Distance to n�arest lot line-Z.6--------- <br /> Nu4mber of lines---------3___ - -----Len4th of each line-4 <br /> Width of trenc ----------------- <br /> -Type of filte� mate ------------------ <br /> rial---- le------Depth of filter material-----Af---- -----Total length <br /> Se -kqe Pit. Distance to n'earest we1L_-'1JV----------Distan-e f -foundation----ff92---------Distance fo'�earest lot line- --42-I------- <br /> epc I h- -/ <br /> Number of �iis...2—-----------:Lining material---- _6/e,___S1ze: Diarnefer-3.3------ -----De'pf __S-------------------- <br /> Cesspool: Distance from nearest well-----------------Distance.-from foundation-------------------- Lining.m.aterizil------------------------------------ <br /> 0 Size: D�arneter---- ---------------------------------Dept h----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------------------------- -----------------------Distance from nearest buliding----------------------------------------- <br /> Distancato nearest lot line-------::-------------------- ------------------------------------------------------- --------------------------------------I---------------- <br /> Remodeling -and/or repairing (describe):-------------- --------------------------------------------------------------- --------------------------------------------------------------------- <br /> I ------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------- ---------­-------------------- ------------------------------------------------------m-----------------------------------------------------------6---------- <br /> ------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- <br /> I hereby certify that I haveprepared this, application and that the work will be done in accordance,with San Joaquin County <br /> ordinances, State laws, and r s . nd dre ula+1 s o the San Joaquin Local Health District. <br /> (Owner and/or Contractor) <br /> - ---------- -- ----- - -- <br /> �d s- yl <br /> -u-l'+'o <br /> (Signed),. <br /> ----------------------- <br /> ------------------------(Tif le)------ ......... <br /> By:------------------_---------------- ---------- - -------- -------- <br /> lot, 'of <br /> (Plot plan, showing size of 16cation of yysfe�m in,relation to well buildings, efc.' can be p!aced on reverse side. <br /> FOR DEPARTMENT USE ONLY <br /> DATE' ---------------------------------------------- <br /> APPLIC�ATION�ACC�E�PTED 'BY ,--- ------------------------------- ------------------------------------ ---- <br /> ------------- DATE---------------------------------------------_------------ <br /> REVIEWED BY------------------------------------------------------------------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------- ----------------------------------------- --------------------- DATE---------------------------------------------------------!---------- <br /> Alterationsand/or recommendations---------------------------------------------- - -------------------------------------------------------------------------------­------------------_------- <br /> ------------------------------------------------------------------------------------------------ ---------------------­­ ---------- <br /> -----------------I----------------------------------- -----------------I----- ------ 4 1 <br /> -------------- --------------------- <br /> --- ------------------------- ------------------------------------------------------------------------------------------------- ---------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------­------- --------- ---------------- --------- --------7----------------------------------------- ---------------------­------*-------------------------------------- ---------------------- <br /> FINAL INSPECTION By::7.9�j-------------------------------------- Date...... ---------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, Californta <br /> ES-9-2M Revisecs 1-57 F-P.CO. <br />