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Permit No. APPLICATION FOR SANITATION PERMIT : (Complete in Duplicate) Date Issued --fes 4 0_ This Permit Expires 1 Year From Date Issued i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 1. This application is made in compliance with County Ordinance No. 549. ---------------•------_--•-- JOB ADDRESS AND LOCATION-- ----------------112'c�--• ----••---- ------- ----- -------- Phone---•�_��------------- - - ------------------------- Owner's Name---------------------- 4 -�----- ._ �`-Q--- -----•-------- Address------------------------------ 1 Contractor's Name ---------•---•- ----••-- ---------------------------•----- Gommercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: _Residence Apartment House ❑ ❑ , Number of living units: �= Number of bedrooms Number of baths Lot size .-_____' ___ C4 P ------- ' Private, Depth to Water Table '�?' ft. Water Supply: Public.system ❑ iCommunity system ❑ a a Adobe. Hardpan ❑ Character of soil to a depth of 3 feet: Sand F1 Gravel C3 Sandy Loam ❑ ClY Loam ❑ Cly ❑ Previous Application Made: Yes ❑ No 12�, New Construction: Yes ❑ No FHA/VA: Yes ❑ No El ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'permitted if public seyrer is available within 200 feet.) / .. t - ----------------- AJ Septic Tank: Distance from:nearest well --------Distance from foundation___._ ._�-___._-.Mater�L_. No: of compartments- Size----- . - --�Liquid depth-- yr Capacity 1 1 / Dis oral F.iel .D' "tante rbrri nearest well_.__ 1�._ _-(.Distance from foundat�ion..__ __6 .Distance to nearest lot line Len th of each line__- Q �p yQ-Width of trench'-____�------ 4• ; um e of lines------. g } a ------------------------------ ----- � ��ff Tot I len th- l d r er materialDepth of filter matenal__...�_:�------ -- g } See a 'w i s istance to nearest well Distance from foundatson--------------------Distance to nearest lot line______._ _-i-- . D'sarneter --------- -- Depth. Number of its.... material_____ Sizt, 1 P ---- Cesspool: /`r Distance from' nearest well---_'.__-_--_.-._ Distance from foundation--------------------fining material----------------------------- els. 1 s ❑ �"� Size: Diameter------------- ----- Depth------------------------ Liquid Capacity 9 f ` i .l Distance from-nearest building----------------------------------- - (� Privy: Distance from nearest well------- a ---------- ---- s: ----------------------- �_---- ------------------------- ❑ � I� (/®istance to nearest lot line.__---------------------------------------------- 0 -._____---- ---- s 1 P g .. Remodeling and/or a rin de�tribe}: t - ti r 1`.� ------•---- d -------- --------- _ _ ...._ _____________ TTTiii __ ----------------------_____________ __ i ------------------------ ...______ _ __ __________________ ______________ i i I hereby certify that I have prepared this application,and,the+,the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San*J aq i�LocalyHealth Diitrict. {\, `" { P ` �. . - 3�- .o wne r Contract ---- ----------- ------------- , (Signed)_. --- ------- ------ . . l z p [plot plan, showing size' oflot, location of system in relation to wells, buildings, etc., can be laced on reverse side). i A FOR DEPARTMENT USE,ONLY ------------- APPLICATION ACCEPTED BY_: _ - --- -------•---------------•-----1------------------=-- DATE---� - --- -�- ------ ----------- --------� - BUILDING PERMIT ISSUED----, ------------------------------ ----------------•-—---------- = DATE.. ----------- - Alterations and/or recommendations---------- ------- I - ------------- ---------------------------- '74 - - ------- - ------------------ ------ --------------------4,` t [th7 .1,/�► -.�. --_C----- " G c.ut. � FINAL INSPECTION BY------ ---------------------------------------------------- pate---- --------------------- -------------- -- --------- -------- ---------SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y' y ES-9-2M Revised 8-'59