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IX FOR OFFICE USE i _ Permit No. ------- -- ---- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued --------------------- -- :-- .This Permit Expires 1 Year From Dafie Issued Application is hereby made to the San Joaquin Local Health District for ermit to construct and install the work herein described. This application is made in compliance with ounty dinance ' 5 JOB ADDRESS AND LCTIQt j !f --- - Phon _. Owner's Name----------------- ----1_--.. ---...... ----- :: Address--- -- --------------- --------------- - 'l / +' r ------- Contractors Name---------------------------- Installation will serve: 'Residence Apartment House ❑ Ymmerci ___ Trailer Gourt ❑ Mo#el ❑ Other ❑_ ri ,� X, p.--- ------- Number of living units: .____ Number of bedrooms::��Number of baths ----- Lot,size ___________ ___________ Private ❑ De th,to Water Table.S"Dft. Water Supply: Public system , Commuriity system Elp It Character of sail to a depth of 3 feet: Sand [j Gravel [I Sandy Loam ❑ Clay Loa C] Clay E] Adobe[ Hard No € J Previous Application Made: (If y'es,date---.___s._F._.____--__)> No K New Construction: Yes ElNo [ FHA/VA: Yes ❑ TYPE OF INSTALLATION AND'SPECIFICATIONS: (No septic tank or cesspool permitted,if public sewer is available wi+hin.200 feet.) Material------------------------------------------------- Septic --- ------------ ---------------------•-------• Septic Tank: Distance fr r nearest*well_---------------Distance from foundation..__.______.--___. nfxjS A'4 No. of com artments-- -- - -----Size------ •-----------------------Liquid depth--------------------------Capacity--------- a �� ] a wy "I 2.1to--.__Distance to nearest lot line__ . Disposal Field: Distance from nearest well'IyG/1�_ -Distance from foundation:____. f -- Width of trench_ _______ _______ Number of lines__- __. __._ Length of each line___41-42` ---- r �' Type of filter; materiaL__.-R Q_ _f ' :Depth of filter material______/_ ___h-_-Total length__ __________ Q r __Distance to nearest lot line_1"Q p 9 - - foundation_ -••- See a ePit: Distance to nearest well; _ _cg11r�__Qistance from i Number of pits-- -FLining material_&-iZK_-Size: Diameter-_-II-s`�----------Depth-..�-5------------------ 0- ---- - V} ` ,-pistance from foundation....___..___i__"Liriing material-------------------------------------- - Cesspool: Distance from nearest_well___,_._.__ Y__Li-id Capacity -----------------------gals, Size: Diameter = Depth--------------------- ------------------------ q p Y . Priv Distance from nearest-well-_'_.----�-y_,----- -�`, Distance from nearest building---------_-------------_•.------ ------- Y�.i - = ❑ Distance to nearest lot line_____________ -------------••- Remodeling and/or repairing (describe)=. _- __ __ __"- 47----- � • E r_ 1 ---.------------------------------ ----- --•------------------------•-------------•-----------""-- y a --- ------• = ---------------------------------------- ---= ----- --------t ---- --------------------------------------------------•------•---------•------------------------------------------------ I!hereby certify tha+ I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances.11a aws, and rules and regulations of #h San Joaquin Loc ealth District. r 6_ -------------------(Owner and/or Contractor) - - (Signed)_ - --------- - I By:------._-------------------------- ------------- Title------------------------------------•------- - ---------------- 1 (Plot plan. showing size of lot, location C)LsysfOnin relation to wefts, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY , �r-----�`----��-�------------------- APPLICATION ACCEPTED BY__ - -A--C-=---f/ — ----------------------- _ DATE-.---- - --------- - 1 -- DATE----------------••-----------------------•----•------------- EREVIEWED BY------------------------------------------•.--------------------------- •-------------------- BUILDING PERMIT ISSUED Alterations and/or recommendatii ons:----- `------------=----------- -----------------•---•--------- ---- t ---- - - ------- , ---- ----- t FINAL INSPECTION BY: .'_ - Date-------- "� � ------ --------•---------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5.9 REVISED M-59 F.P.CP�2M 6.60