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FOR OFFICE USE- <br />-----------------------------7-- ---------- <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------------- ---------------------------- Permit No. <br /> - <br />---------- ----------------------------- ------ --------- <br /> (Complete in Duplicate) Date Issued �_Aa <br /> ------------------------- ------------------ This Permit Expires I Year From Date'lssued <br /> Application is hereby made to the San Joaquin Local Health District fora-permit to construct and install the work herein described. <br /> This application is made i'n compliance,.with County Ordinance No. 549. Portion lot 1 & 2 Blk; I <br /> T�goqso--�-, . - - _1 - rMorada #3 �40- <br /> L -CATION-------i--------I........ <br /> JOB ADDRESS AND 6r�idg.ZE.J& Alhambra -�­ S .E. corner 0 ft <br /> ..................I--------- -------­----­------------............................................................................... <br /> Owner's Name-- ...P��!Scoe c&_,!T C --Qny Lozano 'Ien--------------------7-------- Phone.R9_�_6!n2358-------- <br /> "42 n ox Lathrop ...............I................. <br /> Address-----------------------5 �Lexi ton 'Ave ....................................... <br /> ....................----------------------------------................................ --------------------- <br /> Contractor's Name.T-h@---DAY--&---NI-GHT-Sept__i-c...*T-a-n-k----SVC.................................................. PhonejqP...6t3B.41------- <br /> ry <br /> Installation will see: Residence 9 Apartment House I Commercial C] Trailer Court []. Motel 0 Other 0 <br /> Number of living units: I---- Number of bedrooms k Number of baths -__I__. Lot size <br /> Water Supply: Public system El Community system El Private De-Depth to Water Table Znt. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel n Sandy Loam E] Clay Loam [I Clay 0 Adobe Ce/Hardpan C] <br /> Previous Application Made: (if yes,date--------------------1 No E] New Construction: Yes [:] No FHA/VA: Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> (No septic tank or cesspool permitted if psK,�ewer is available within 200 feet.) <br /> Distance from nearest I$ Disfr ......M, <br /> Septic Tank: op). iteria------- _���-z _o <br /> _�o <br /> No. of compartments-- -Size,, ----- iquid clep�h----%:rjr- _-A-----Capacity........ <br /> f Udc <br /> 0 a_._...Distance to nearest lot line..*-------12.5.. <br /> Di al Field. Distance from nearjef well---1 ---------Distance rn foundation...,o <br /> Width of french..... . ... ............... <br /> Number of lines. Length of each line <br /> Type of filter material .-Depth of filter material----/�u----------Total length----------A........ --------- <br /> SeeJ, ge Pit: Distance to'neares well----1--O-D.......Distan omjoundation--./.-L'I-f.-.'Distancl,, to nearest lot line <br /> M ----- ........ <br /> Number of pits-_ .1--------------Lining material. -----K_--.Size:Size: Diameter--1513--- Depth._.___. _,_x..... <br /> Cesspool: Distance from nearest well--------------.-Distance from foundation------------------- Lining material____._.______._..-_____.________.__.. <br /> ❑ <br /> aterial------------------------------------- <br /> El Size: Diameter------------az.----------------------Depth----------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well------------- -----------------------------------Distance from nearest building-__--______________-_................... <br /> ❑ Distance to nearest lot 11 ------------------------------------------------------------------------ _ <br /> -------- ------------m-------�m----------------------------- <br /> s" <br /> Remodeling and/or repairing (deicribe):-- --- ------------------------ --------- <br /> - ! - -- - 4- ---- --------- <br /> ­ -------------------------------------- ---------- --- ----------------- ---------------------------------------- <br /> ------------------ ........... ------t------ ---A---------- ------ --- ---------------- <br /> --------------­-­--- ------- - <br /> -------------------------------------- <br /> --------•------------------------------------------- ------------------------------------I--------------------------------------------------------------------------------------------------------------•--..-.-. . <br /> I hereby c i1fy that I have prepared4his application and that the work will be done in accordance with San Joaquin County <br /> a and s <br /> ordinan rul�n _Vul t, )f equip Local Healt District. <br /> 'o <br /> ar Contractor) <br /> &:_ ----------- ------ --- - - -------------------------------------- <br /> (Signed). ------------ - <br /> By:----------------------------------------................... ----------------------------------- - ------(Title)--------------------------------------- ---------------- <br /> ------------- <br /> (Plot plan, showing size of lot, location of system in relation to w, buildings, can be placed on reverse side). <br /> r <br /> 4 <br /> 1.71 9a <br /> FOR WART K)tNT USE ONLY <br /> APPLICATION ACCEPTED B - -- --------- --------------------------- DATE-•---- -- <br /> ---- ------- 7 <br /> a . <br /> REVIEWEDBY---------------------------- -- ------- --------- --------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED- --------------------------------_------------------------------------------------ ----- DATE--------------------------------- ------------------........ <br /> Alterafionsand/or recommendations:------ ------------------------------------------ ------------------------------------------------------------------------------------------------------------- <br /> .......V-V-63----john-Day---xe_turned._hiS__CQP_y_0_f---this__pexm;Lt__.m_at&ting_.he..d1d---no-t---inatall---t I xp-...a y.s t-em <br /> ..........................TA_aPPe_ar_S--- ---pez3_t_Xo,_14322_-.R1C/-tf----------------------------------- <br /> .......... ------------------------ --------------------------------------- ---------------------------------------------­­­------------- -------------------------------------------- ---------------------------- <br /> ----------------- ---------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- ...... ................... <br /> FINALINSPECTION BY:---------------------------------------------­­........I------- Date----------------------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 360 West Oak Street 124 Sycamore Street. 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 9M 5-61 AILAS <br />