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A APPLICATION FOR SANITATION PERMIT ' ~ -Permit No. 124..7-� (Complete in Duplicate) /d L Date Issued -•---�7__ --� {. This Permit ExIpires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wortherein oast This application is made in compliance with County Ordinance No. S49. JOB ADDRESS AND LOCATION__ .-..-_CrE� r ------ Owner's Name-------•------------ '7-4a--------- ---------- Phone------------'---------------••----- Address---------------------------------------------- x ------- ------ ----- -- -- -- A ��--=---------••--------------•---••------•- Contractor's Name--------------J" --------------------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel C] Other C3i ; Number of living units: __4 Number of bedrooms --- Number of baths _9-_ Lot size - --.•s------------------------•--•- Water Supply: Publiclsystem ❑ Community system ❑ Private Z�Depth to Water Table J-1-1F. Character of soil to a depth of,.3,.feet-; Sand Gravel E] Sandy Loam E] Clay Loam [IClay ❑ Adobe ElHardpan ❑ 4# i _,,� Previous Application Made:',;Yes ❑ No New Construction: Yes ®''No ❑ FHA/VA: Yes ❑ No El TYPE OF INSTALLATION�AND.SPECIFICATIONS: (No septic tank or cesspool permitted;if'public sewer is available within 200 fee .)+ J ,--. Septic Tank: Distance from nearest well_�U_-_ !stance from ounda on= _ _ �at real___________ __________________!______-----_____. No. of;compartments_._ ~ - ---Si, depth„___`___ Capacity - fid_. --- Disposal Field: Distance from nearest well/06istance from foundation__A0. stance to nearest lot line... of lines_'.._ Length of each line----- i _-____�j__-_-Width of trench------- J._____------------ --------- _______-__ ,.. }} Type of:filter material_sS l -Depth of filter materia4____�_ ___._.___Total length______ �.Q______________________ � Seepage Pit: Distance to nearest well____________________Distance from foundation--------------------Distance to nearest lot line_________,_:_:_ ❑ Number of pits----------------4- ---Lining material-----------------------Size: Diameter------------------ -- Depth- ------------------------------ "1 .�,.. Cesspool: Distance from nearest weil-----------_____Distance from foundation_________________.Lining material_._________-_.__________.________. ❑ Size: Diameter---------------=---------------------Depth------------------------- --- ----- ----------Liquid Capacity----------------------------gals . Privy. Distance_,from nearest well-.-!------------------=-----------=---------------Distance from nearest building-----------------------------------------_ ❑ Distance .to nearest lots -------=-------------------- ---------- --- '---------------------------------------------------------------------------- Remodeling and/or repairing (descr!be):-------------------------------------------------------------------------------------------------'------------, <------------------------------------ ! .,-r- ! i ai a . -----_-' --- `c='--------`-- ---------------- ------------------------------------------------------------------------------------ --------•---------------------------:__----t2- ------- I m hereby certify that l.have prepared this application and that the work will be done in accordarice"witla San Joaquin County ordinances, State laws, and rules and regulations of;the San Joaquin Local Health District. . . (Signed)-=:7, - _, I r 7:.:.- =-:-�,(Owner and/or-•Contractor) !x By:. = Y (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side). FGF-DEPARTMENT USE NLY IAPPLICATION ACCEPTED BY----- -- --- --- ---- m ' "' DATE__1 ___ -----54,14-0--- ------------ - -- iREVIEWED BY ------------`------------------------ ----- ----- ------------------------------------------------------------------- DATE BUILDINGPERMIT ISSUED------------------------------`-------------------------------------_--------------------------- DATE-------------------------------------------- ------------- Alterations and/or recommendations: -------------- = ------------------- -- --- --------- �� , � ---- P� ��. � c1 =co�lf > D_. ��K.------ ---------- - -------- ----------------------------- -- _-�r ---------------------- - �- - ----- --------- ------------------ -------- -------------------------------------------------------------------------- ------------- ............ --------- -------- FINALlNSP -- ---- Date ---------------------------- ----------- SAN JOAQU.IN LOCAL'HEALTH DISTRICT 130 South American Street 300 West�Oak 5treot 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co-