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`, Permit No. ' APPLICATION FOR SANITATION PERMIT.,,,-T r (Complete in Duplicate.} ,y Date Issued ."_1_�_-t o -_n) Application is hereby made to the San`JoaquinLocal Health District for permit to2onstruct and install the work herein described I This application is made in compliancelwith County Ord' ante No.. 54.9. , Y- _�� - = JOB ADDRESS AND CATI -- --- -- -- { --- Phoney Owners Name-------- --• - -• ------- A ------ ---- .-�• r... -�r+...w-......w,nrrn.r...�...- OrfFr�.» L1' "--- -•_------ Contractor's Name---------- ---- - Installation will serve: Residence iApartment House ❑ Commercial ❑ Trailer Court ❑ Motel Cher ❑ k 1 S � / 2 Number of living units: __ -_- Number of bedrooms _ Number of baths -- -__ Lot size _--_ -- /--� ' i Water S�pply: Publicisystem Commuriity system ❑ Private ❑ Depth to Water Tabl _-ems. ft. Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ -Adob ❑ Hardpan ❑ Chars 1 P / Previous Application IJade: Yes [INoRr New Construction: YesR�No ❑ FHA/VA: Yes ❑ No &` TYPE OF{ INSTALLATIiON AND SPECIFICATIONS: I ` ess ool permitted if public sewer is available within 200 feet.) (No septic tank For c p p I eptic Tank: Distance from nearest well from foundation_----___----..-----.Material_-_------------_i---------__----___----------- Nod of compartments Size-,ksLiquid depfih------"----- Capacity. Disposal ' eld: Distance from nearest well------------------Distance from foundation---------------_---Distance to nearest lot line----_----_-.--_- 1 `Number of lines --------------------------------Length of each line------------------------------Width of trench----I------------------------------ Type of filter material-------------------------Depth of filter material----------------------Total length-----------(_=------.--------------------- 3, r '_Distance to nearest.lot line-_- - __-- Seep ge Ft: Distance to nearest well--- from fo dation --------- -. Size: iameter___ ..---_____Depth__ �. ----------- Number of pits---"-�-----------Lining material -.--- .3 Cesspool: Distance from nearest wellDistance from foundation------------------- Lining material-___--1-----_"----__------------_---". ❑ Size: Diameter ---"- Depth-----------------------------------------------------Liquid Capacity.-..' ga. { i ------__--Distance from nearest building Privy: Distance from nearest well------------------------------- ❑ F + ------------------------ Distance to nearest lot line----•---------------`---------�----------- -------- --------- I Remodeling repairi'nc�(d - ___ ----- ------- - -- -- r---- - -- • ' 1 here . certify`that I have prepa, f is applicatio nd that work `II be done in accordance with San Joaquin County ordinance , St laws a rules an r t' ns of th ,S n Joa i Local alth District. I - (Owner r Contractor) (Signed)-- - ---- = ---- --�___d -it e- --" -- :-------- (Plof'plan, showings e i system in relation to wells, buildings, etc., can be pl reve a si PART ENT US ONLY DATE - -- ------ ---------------- APPLICATION ACCEPTED BY -j -- --- --- -- t ♦ -- - j-----•_-"•-------'---------------- REVIEWEDBY-------------------------------- ------------------------- ---------------------- -- BUIL ING PERMIT Dat ons and/or recommendations: --- ---_ ndations--- ---- ----- -------------- - ---------- --•------` Alter -----------------------------DATE-------------------------•-=---- ---- ------------;�---- -- --------------------------------------------------------------------------- ------------•---------------------------------=------------------------------- ------------------------------.-•------------------------------------------- --------------------------- --------------------- ( - --------------------- -------•---------- ----------"-------------------------------------•------------------------- - - ------------------ Date------M11 - -----�--- --- ------------------------------- FINAL INSPECTION BY:.- -- -----"-- ---- /------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1.57 F,P.CO.