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APPLICATION FOR SANITATION PERMIT Permit No. <br />(Complete in Duplicated Date issued <br />0e) (- 0 - 2-/ <br />ode to the Son Joaquin Local Health Dls+rkf for a permit to construct and install the rk herein described. <br />wO <br />ApPica"lon is hereby m r nan�e <br />This 'application is trade in compliance with County 0 d,iNo. 549. <br />JOB ADDRESS AND LOCATION-..'. .?hone... <br />Owner's N .. . .... .. .................................. <br />---------- ....... . ....... --------- .......... <br />Address_-_ ...... ..A,. <br /># . 00. ... ............ <br />.... . ... ercia! Trailer Court 0 Motel 13 other 0 <br />Iristailation will serve- Residence RIIAV;rrfment House Comm <br />Nurnber of living units:,. Number of bedrooms ... Number of baths V. Lot size .......... <br />Water Supply: Publk' system Community system [] Private @4.-ae-pth to Water Table .44 ft. <br />Character of soil to a depth of 3 feet: Sand [] Gravel 0 Sandy Loam fray Loam 0 Clay M Adobe 0 Hardpan 0 <br />Previous Appi;cafion Made: Yes 11 No 44____j*.,4ew Construction: Yes 29-146-Q, <br />TYPE OF INSTALLATION AND SPECIFICAT!ONS. <br />(No Septic tank or cesspool parrmitfed if publics ewer is available wWtn 200 'eet'j <br />Liquid depth,.Cap?,,, <br />No. of corrPart­n071ts­ ...... Size ot line... <br />r_Djstanca to nearest I <br />Disposal Field- Distance �,rom neares, WC4 D;stance* tram founclz 0 of french ............ <br />'? Lenqfk of Number o; lines_..-..•.. ... . . .... <br />Terial ... Depth o� filter mate, al­ <br />.ypo oz filfer materiel.- to nearesf lot <br />res, WeIL _Distance from foundation <br />Seepage Pit: Distance to n" �Iz <br />Lining rnaterial.._.: ....... ....... S_ a: D'amefer.. ...... ....... _ Deptn........... <br />Number of <br />f <br />Distance rom nearest esDistance from fouftdaj:on.._._ _ ....... Lining materlal_._ <br />Cesspool:- ­1 _Liquid CaPacitY­ .... ...... ....... ...... 96 <br />S:ze: D:arnotor_ .... Depth .... ...... <br />Erase nearesf building._ ..... <br />Privy- Ms4ance from nearest ---- -- ---- --- ...... ....... .......... <br />Distance to nearest lot ,.re_,........., ....... ___ ............ <br />repairing - - - - ----- ------- ...... <br />Remod'eiing and/or re . .. .,..»».... . .... . . .... <br />............. ........ . . ...... ......... ------- - . . ....... ............. ...... <br />..................•_...........:._,_..,_..­­ .............. .................. ......... <br />................._.....,_.............»...._.-.........._.__ <br />..........­........ ......­­­.........­­­ ................ ...... <br />hereby certify that I have prepared this applic <br />' tion and that the work will be done in accordance with San Joaquin County <br />a laws, arid rules of and regulations I the Sari Joaquin Local Health District - <br />ordinances, er­enJ�" Contractorl <br />................ 40wne <br />i7o -�_Pl� aced on to side). <br />(Pilot Plan wiW showing sof-14t, location of systern'tri <br />FOP, DEPARTMENT USE ONLY <br />DATE__ <br />DATE.............APPLICATION ACCEPTED BY__ <br />?REVIEWED 8Y__-_-, ....... ... ... I ...... ........ . . DATE. ..... ..... ................_......».w. <br />........ <br />BUILD] N15.?ERMiT ISSUED ............ .... ........ ­­­.............-----..»..._...__ ...... . .... <br />Alterations and/or -recommandat;ons-..�,�.,,�.� ........ . . . ......... <br />.......... . ....... . __­­ .......... . .......... __­ . . ...... <br />... ....... . ..... ...... . . ............ - ... . ... "........... ........... <br />.......... ................ ........... ..... ............... <br />........... <br />........... <br />Date__ I ........ ....... <br />NAL INSPECTICN 817-�O­ �­ .. .... I ....... -- <br />"I SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North 'C" Stfs*t <br />130 South Amark*n Street 3DO West Oak Street 132 Sycamore Street Tracy, California <br />Lodi, California manists'. California <br />califorfiid <br />,Ina, 111 -6 ^-C -o ._­ <br />