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u0 APPLICATION FOR SANITATION PERMIT Permit No. ` > (Complete in Duplicate) sued This Permit Expires 1 Year From Date Issued Date Is Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance with County,Ordinance No. 5;4.9. JOB ADDRESS AND LO TIO Jr C� lr`.t `"." "----- - ---------------•-------------------------- Phone------------------------------------ Owner s Name---------- - Address--------------------��--1� �----- rP-•--------------- --------••-------•--•-----•------• Y � ----- Phone---------------------------------- Contractor's Name-------------•------------ Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: " '" Number of bedrooms _.Number of baths -_Z__ Lot size ��' � &j-- Water Supply: Public system w Community system ❑ Private ❑ •.Depth to Water Table � rft• Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes g2"IN-o ❑ FHA/VA: Yes ❑ No &0 " TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if V) Ver is available within 200 feet.] 1� -----------MafVI----.d-� �"G ------------- i�---------T nk: Distance from nearest wel --Distance from foundation__ -- i �� Size x Liquid depth ----Capacity_,,_ _a-------- No. of compartments_"_" .____"._______- " � i Disposal Feld: Distance from nearest well -----Distance from foundation"" j9__---"-...Distance to nearest lot line"" _-_-------- - -----------------Width of trench-_-A&�--------------------- Number of lines--------- _."__"" Length of each line__�.Q �� L y� p Total length -------------------------of filter i-AaferialJ�` ''""Depth of filter material----.fd_-___----- g �f-- Seepage it: Distance to nearest well___--".-�'___---Distance from foundatio �_--".D�s ��e to nearest lot tiny_ """__ Number of pits....":_1°------------Lining material"_Xe -Size: Diameter Linin material±h.---.. �.-"----- ------------------ �{ Cesspool: Distance from nearest,well_---------------Distance from foundation__-.-_-----------_ g Size: Diameter ` ❑ -----------Depth-------------------------------------- -------------Liquid Capacity----------------------------gals. �' -.------- Privy: Distance from nearest well--------------------------------------------------Distance from-nearest building-----.----.___-----------_--___.-.. ❑ Distance to nearest lot line-.--- ----------- ---- ------------------------------------ ---- ----------------------------------------------- i q ' Remodeling and/or repairing (describe):---------- A -- = ------------- ----------- `e l .j-(l '' l F y4e1;09y-__'05! - r ereby certify that I have Arp-ared this application and that the work will be done,in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r ----------- -------------------------- (Signed) Contractor) ------ ---- F -'--- -'------- - - --- -r ,fl-Plir (Title)- - - - (Plot plan, showing size of lot, location'of s min relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED)BY-_-- -- DATE----- -- eF "�- ------ —� ' _-. REVIEWED 13Y-------- -------------------------------- -- ------------------=------ ------ - ------------------------1--- ------ DATE---------------------------------------- _ BUILDING PERMIT ISSUED------------------------------------------- ----.- Alterations and/or recommendations---------------.__.----------- ---------- -----•------------------ , �o '--1 r - -------- �__ - - : --------'- --- •-------- --------- ----- ------ ------ - -7--------------------------------------- a—It ---------- ------ ------ -- f 3 g-"` -----Date--�----� �-- - ------------------ --------------- FINAL INSPECTION BY:.....-.Y- ------------------------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stra t ,.,- °1 132 Sycamore'Street 814 North "C" Street , Stockton, California Lodi, Cslifoinia� ' ; Manteca,California Tracy, California r _..- ES-9-2M Revised 8-'59 FY.Co.