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,FOR OFFICE USE: o'wi wn� -- f -------- �-= Permit No. ...�-�_: I ---- ------------------------------- / := P ICATION FOR SANITATION PERMIT �ii (Complete in Duplicate) Date Issued -------- -----•-•-Y� ------------ ' This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and insiail the work herein described. This application is made in compliance with County Ordinan N 9. + l ------•-------- JOB ADDRESS AND LOCATION..t ------- -------------- -- owner's Name G Phone f --•--- Address--------------- ------ip----------------------------------------------------------------------•-----------•- / ----•--•.._. Phone —--------- �--•-- .Contractor's Name d , III Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other Installation will serve: Residence ❑ Ap ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size -----_7� _.. °�`5 Water Supply: Public system [iCommunity system ❑ Private ❑ Depth to Water Table pan Character of soil to a depth of 3 feet: Sand ❑ Gravel F-1Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[I Har No ❑ N . Previous Application Made: (If yes,date ------- No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ �$ S TYPE OF INSTALLATION AND SPECIFICATIONS: 0 feet. (No septic tank or cesspool Permitted if public sewer is available within 20 ) S :ptic Tank: Distance from nearest well________________Distance from foundation____-_ _Material Liquid de th_:____.__ _ .-.---_ Capacity ❑, No. of compartments--------------------------Size--------------••---------------- q P - - - --'- ------ ----.. -----•--- I Disposal Field: Distance from nearest well._.______--_-___.Distance from foundation------------____....Distance to nearest lot line------------.---- , -•-------Length of each line------------------ -----Width of trench----------------•-------- ------• �. ❑ Number of iines --------------------------------- Type of filter material____ -------Depth of filter material-----------------------Total length-----------------:-------------- � ! Distanc m foundation__ Q_�."___..Distance to nearest lot line__.-_ ----- v Seepage Pi}: Distance to nearest well_ ____ ____________ -i —t Number of pits- ----- ---------- --Lining material C- '----Size: Diameter--3-c3-----------Depth-----P - ------------ •------ - Oesspool: Distance from nearest well___________--Distance from foundation'.--_:____-----__..Lining material._-_. als. Size: Diameter-------------�----------------------Depth-------------------=--------------=-----------------Liquid Capacity---------------------•-- 9 ❑ . �if t' Privy: Distance from nearre'stedll' ?-------------------------------------------Distance from nearest building-------------------------- ow I ❑ Distance to nearest lot line_-- -------- ----- . ---- -- - ... -- --f'� ---=�fi'�-�- -- -- -- --•---- ---- Remodeling and/or repairing (desci•ib�}'__ -- _ ---------------------------------------t--------'��.:�.-.��_s��i-•-==----•-----�- i �'�1s---= --------•----- -• -------- - -- •--------------------- -------------- -------- -- ------------ ----------------------------------------------------'--------------------------- 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, and r les and gulations of the San Joaquin Local Health District. r � � _ (Owner and/or Contract or (Signed)------- - ------------------------------------------------------ (Title) --------------------------------------------------- By:---------------_ (Plot plan, showingMsize`of lot, location of j stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY tDATE.. G --------------------------- IAPPLICATION ACCEPTED BY----- ---- ------ ''-------------------------------------- REVIEWED BY.------------------------------- ------------------------------•------------------------------------------------------------ DATE......----------------------------------------------------- BUILDING PERMIT ISSUED------- --------------------- DATE--- --------------•------------------------------------- 11Alterations and/or recommend ations:--------------.----------------------------------- ---•---------••---- t ----•-------------' I ----------- -- ----------- ------------------------------------------------------------------•---•------------•------------------------------- ---------------- - --------••-_----•--------------------------- •-•------ ----- --------- - - - ------------ 1 - ------------ Date -- --._4P' .. I FINAL INSPECTION f3Y: ' �`----- --- -- •- SAN JOAQUIN LOCAL HEALTH DISTRICT 14A Sycamore Street 205 Wast 9th Street 130 South American Street ,�' 300 Wast Oak Street SManteca,California Tracy,California Stockton,California Lodi,California t EB•Y REVIBEO 8-59 F.P•rio•aM 6.60