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Application is hereby made This application is made in JOB ADDRESS AND Owner's Name APPLICATION FOR SANITATION PERMIT Permit No....Il..... (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued .._l__/�l___ the San Joaquin Local Health District for a permit to construct and install the work herein described. npliance with County O dinance No. 5 ,�9. } w + N-----7 ► ---•----------------------------------------------------- ----------------------- 4-. Phone ------------------- -.:.._--•-------- Address----- -----------•- ---------------J..[ - Contractor's Name ------ -- _ Phone______________ -----------------------•------•----•-----------------•--------•-----------•----------- - ------•--------------••••••---••-•----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ IM_ Lot size � �N'umber of living units:, __/___ Number of bedrooms _a-_ Number of baths Water Supply:; Publi systelln :®��ommunity system _ PriPriyate ❑ Depth to Water Table_ A/1 ft. Character of soil to a depth of 3 feet:_ :S"and ❑ _Graver ❑ Sand � Loam Clay Loam Clay Adobe Hard an i Y D Y ❑ y❑ � P ❑ Previous Application Made. Yes Q No P�r_ New Construction: Yes @?'�o ❑ FHA/VA: Yes 94-01No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted.,if-public sewer -is, available within 200 feet.) . P :i. ii y Mat rials L Septic Tank: Distance from nearest well_ /"Q-__ Distant f m foundation__._ No. of cl mpartments---------------- ---'Size--_ + .4(4. ---Liquid d'�th4-------------Capacity---- ----- 10 Z Disposal field: Distance.kfrom nearest well1`09_____ Distance from foundation._.��° _____.Distance to nearest lot line, --- 9 �`�_____ [' Number bf lines ________/ _ °__�--.Len `th of each line__ __ _.___ _ _-- __ Width of trench____ _ ___ Type of filter material_,r_-_ `_� epth of filter material-_ ,e-!? Total !en th____ __ Seepag Distance 1. nearest ell-- -a _____Distance f,r�' foundation__ _.___ D trice #o nearest lot line-_to— to---- ------ Depth 0 Number of pits_.. _______Lining material__-I_��_Sixe: Diameter.j`r p _ s Cesspool: Distance .from nearest well ----------------- Distance from foundation ----------- .______.Lining material ------------------------ -------- Size: Diameter ----- _-------------------------------- Depth -___9-..___._____ T_-_ ----- -Liquid Capacity ___ gals. ,. _..._ . A.. 7 Privy: Distancelfrom nearest well ------- _----- ____________________.____-__..___._Distance from nearest building ----- :___.___________________.__.___ ❑ Distance to nearest lot line ---------------------------------- ------------- ------------------------------ ------------------------------------- - Remodelin and/or repairing (describe): ----------------- /.�rdL�?1 __4_�;�i�G ----- --------------------------•--------------------- ------------ _..�4T l Tta----------------------- -S-------- .A -S ...... �140AC, 'rte ._�-----aX r ---------------------------------- ------------------------------------- --,----•----------•------------------------------------ -- - --o---------------------------------------- •---------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared,this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, d rules and regulations of the San Joaquin Local Health District. (Signed) :1 -A !90 By:---- -------------------- I' `-------------- (Plot plan, showing size of lot, location yi. . -- ..... ----------- - -- - --------------------------------------- ( ontractor) ., . , - .._ Title stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY y tom` -.-.,...._..=- APPLICATION ACCEPTED BY - iS�t . DATE-- - --- - - - ----- - ------ ---- ------------------------ ------ REVIEWED BY----------------------=!l'-------------------------------------1 L- ----- ----- 1 -- --- - ----------------------- DATE--------------------------- - - -- BUILDING PERMIT ISSUEDA ---------------- D TE Alterations and/pr reco mendat' ns:. ' r -� = a ` � ---------------------------- _ P= = °--- -- -- =--------------------------------------------------------------------- - --------------------------------------------------- - -------------- 0.__ - -- ------ ------------------- --------- ---------------------------------------------- : ---------------------I ------------------------------------------ ---- -- FINAL INSpECTIC>�BY. 130 South, American Street Sock+on, California ES -9-2M Revised 8-'59 F.P.Co, Date - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Was+ Oak 'S+reo+ r 1_ t^jt32`Syeamore Street 914 North "C" Strea+ �v Lodi, California y Manteca, California" Tracy, California