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FOR OFFICE] USE: 3 _ , 4--- : --------- ------- .,3-6 APPLICATION FOR SANITATION PERMIT Permit No. ..... �'_ __ _-_ ---------------I--------------------------- ------------ (Complete in Duplicate) 3 - ,.--_________------------------_........______---------- This Permit Expires 1.Year From Date Issued _ Application is hereby made to the San Joaquin Local Health District for a permit to construct and in nil the work herein described. This application is made-in compliant ith County Ordinance No. 9. - et] No ►�. Y X.4! tJOB ADDRESS ND CAT Q. = Q_!_i£.5.. � 4` vs__ f._. 4 ---- ---------------------- `ff�rL Owner's ;..e = =1° r= '1 --- ------ ----- Ph �-' ---- - - -- ------- 5 Address(------ a �� 6-- ------ = � ... "f� Contract0 e__. _.. -- .f. R�_ ._.._. { t �3 �,----------------- Pha ------ __1 7/ Installation will serve: Residencepartment HouseCommercial ❑ Trailer Court E] Motel ❑ Other ❑ n Number of living units: __ ____ Number of bedrooms_-_ Number of baths +'_-_- :Lot size _Z7_Ae-f!_C-..S'_----------------- ____-___ • Water SuPPIY Pucblic syem , at rComunitysystem ❑ rivae epo Tebleg Qft.� " Character of soil to a depth of 3 feet: i Sand ❑,'`Gravel ❑ Saridy-Loam❑ Clay,L..oam❑ ay ❑ Adobe Hardpan .� V1 Previous Application Made: [If yes,date-----------_--------I No ❑ .New Construe+ion: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool.permitted if p tic sewer,is-available within 200 feet.) ^� e r N '� , /fir ' t Septic Tank: Distance from nearest wet ---_49-----___Distance from found tion___________________ '" No. of compartments---.�___-- ---------SizeZ.� X__�:;_.Liquid depth--- ---- -------;----Capauty---/ .0-0- ion Field: Distance from nearest well _.- �Dis#a�e�lro foundation__, _�__-Distance tonearestlot line___.--- ___- Len �P!' th.of each line_ 0-.Width of french__-S'�'_��_ Number of iinesog Type of filter material. .� �(- Depth-of Cter material_-_ _ -----Total length___________________--_ ---! ----- Se e Pit: Distance to nearest we1E_lt_Q_0___---__Distance.from foundation_-__ Distance to nearest lot line________ x Number of ,ts_____ Linin material_ 4?r_-. .......Size: Diam r ZX------------------ Number �__;_-_--_____ p �----------- g Cesspool: Distance from nearest well________________Distance fro oundation-_--_-__--__-`_ 'Lininq material--------------------------- ___-______. ❑ Size: Diameter--- --------------- --------------Depth-:----------=------- -------.-----------------�-Liquid Capacity---------------------- j--•gal` ' Privy Distance from nearest well---__-----------'_-_____---________-___-_____-:Distance from nearest building------- .------------------------------- -:. Distanceto nearest lot line-------- -------- --------------------------------------------- ---------------;-------------------- ---------- -fit'`- ---- - Remodeling and/or repairing (describe)__________________ --- - T ----------------------------------------------- Il ., -------------------------------------------------- i t ----------------------------------------------------------------------•------ .; hereby certify..tXJquiniLoc ---------- 4 ordinances, State law y y hat I have prepared this applicat the work will be done in accordance with San JoaquinFCounty s and rules .and regulations of tuin'Lac `` ea '� bis#ric#. ��`��'L� *-.�---- ---- --------------------------- - (�Contfactor) g •-- - Y Plot plan, showin size of lot, location of s s+em in re __ -�-anTitle)________'' r--_--_________________ '---._..s .( bings etc;�can be placed on reverse side).-- I FOR DEPARTMENT.USE ONLY I APPLICATION ACCEPTED BY----- --------- ---- ----------------------------------------------- DATE---- --------------- -----I- ---------- REVIEWED BY "- =�--------------------------- --------------------------- DATE - E -------• _...------- BUILDING PERMIT ISSUED----------- _ ____=`DATE------------------------------ --- t j,,,,AI+erations and/or recommendations: - - -------------------------- •--------------�-- ------- -- ----- --- ---- ---------- ------------------------------------------------- ------------=---------------------------------- ------------ -----------------------------------------------------------------------------------------`,----------------------------- FINAL INSPECTION BY--------------C_ Gz7- ------ Date--- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Haxellon Ave- 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED B-59 3M 3-'63 F.P.CG. 1