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t, FOR OFFICE USE: i_--------------- 114-3t-A--- ---- 0 -�+ ------ -----_______ . ;qP- APPLICATION FOR SANITATION PERMIT Permit No. .__I..IQ_1_ G 4 {Complete in Duplicate} ------------ -30- This Permit Expires 1 Year From Date Issued Date. Issued ... Application is ereby made to the San Joaquinealfh District for a permit to construct and install the work herein described. 1 I This application is made in campliancp ytith rdinance No. 549. JOB ADDRESS AND LOCATION_- ..__`"`�. -! ZZ ./� �!{ "' =------ ---73_------��f+o-----`- ------------- Owner's Name r---------------------- ------ Phone-----•---------------- Address----------- -c k r. ltix ,- - - ------ - Contractor's Name----------- J .r ---------------------- ----------------- Phone------------------- Installation will serve: :.Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of-living units. _"^___ Number of bedrooms _�"'_ Number of baths _ 40 _ Lot sizaa// �� ._e2e Water'Supply: Public system ❑ Community system E] Private [�epth to Water Table i-Pbltt- {r Characters of'soil to 4 depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam'[] Clay Loam ❑ -Clay 4.Adobe ardpan ❑ Previous A plica#ion Made`.. lf,yes,date'_� rh ----- No [�rNew Construction. Y- oFHA/� s -." a ,....�.�.. : . ... �`1 ❑ YA: Yes ❑ -Io_ i TYPE OF INSTALLATIONAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feel # a }� Septic Tanks Distance from nearest well__+f -�_Distance, rom fayndatio�n___ .MatBn I___ -- -- � No. of compartments- ' -----------Size -4 •X 1!,quid depth.-._ ` Capacity`, �----- ` ----- Disposal Field: Distance from ne "o t+ arest well._-tr-Q_-.--Distance from foundation--A2_Q-f".---.Disfance to nearest lot linex�7______... -i. .,d s .:1 - x --� ! Y Number filter s:._erial ---- ___-__Length'of each liner `Q_-----Z=_ Widthof trench__,Z_�----______-_ Type of filter materialfl�p44Depth of filter material___-/ `�-__Total length___ �Q-�_-----__ _ Seepage Pit,: Distance to nearest well_,_/ Distance from fo ndation____fi .- ,. T_ _ .Distar to nearest lot line_ Number of pits-_�:,�__-------- material Size: Diameter_-- � ----------------- Cesspool: ---- 1 . Linin m / Cess ool: + Distance from ne'arest�well_________________'Y 3 ------------ _ g P Qisfiance`from .foundation-_------------------Lining material_----__-________----__-___________- . Depth --------------------------------------- Privy: Liquid Capacity g ❑ — Size: Diameter �'�" --.i '� r w------------- ------- r h a Privy: Distance from nearest well_______________________t____--_> '_.'_� _._Distance from nearest buiidin 9---- :------------ Distance Distance to nearest lot line_____________ #, '= Remodeling and/or repairing (describe):_______-_ ------------------------------------------------------------------------•----,-.----?-----------_-_ ------------------------------------------------- ------------r-------------�-- ---- _ _ _________________________t____________________________________________ ____ 3 ------------------------------.------------------------.__-______-__._____ -------------------------------------------------------------- _________________________________________-_________,_-_________- _____________________-_____________-________________-__ '____-_--____--__--_-_I t hereby certify that I have prepared this application and'fihat-fhe work wilk,be done in accordance. Afh San Joaquin County r ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------------------- -� �#'� r 4 - - -------- ------------------ r Contractor} BY: - ----- ----- Q (�i+le} - E (Plot plan, showing.size of iot,.location of system in tion to wells, buildings, etc., can be placed on reverse side). y FOR DEPARTMENT USE ONLY r ------------ I REVIEWEDTION ACCEPTED BY �lL --------------------------------•- -------------------- DATE------ �_...1.-,- APPLIC�ABY------------= DATE ----------------------------- BUILQING PERMIT ISSUED -------------- -----• DATE-- - --------- '- ------------------- - Alterations and/or recommendations:-'_------------__________--._. _ / -----------------------------------•---------------•------------- ------------------------------ - ------------ -- � "6 !!_ars - dYC rllp'------------ _ ------------ ------------------------------------. - a`�n -�'f�- F' -------- _ `e= n ;; �- - ---------------------------------------------- ------- -------------------------- ------------------- -- --------------------------- ------------------------------------ . l FINAL INSPECTION BY:........ _�Go-� Date - -Y- ----------------------------- } SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Ave. 300 West Oak Street 124 Sycamore Street '' 205 West 9th Street Stockton,California Lodi,California Manteccl,California Tracy'Tracy,California ES 9 REVISED 8-59 31A 3-'53 F.p,CD. 1. '°'"