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'-"APPLICATION FOR SANITATION PERMIT Permit No. J ` ��(Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in 'Compliance with County Ordinance No. 549. %,/�®� JOBADDRESS AND LOCATION ------------- Lot ---- # ----------------------- -------------- --------------------------------------- -- OwngksName ------ Wo-ciAbmidge ---- Re.a.1ty ................. I -------------------------------- ----------------------------------- ------ Phone ------------------------------------ 1902 Pj.,jfjc Avenue ----------------------------------------------------------------------------------------- ....................................... Address--:. .................................. . ................ .................... Contractor's Name ----------- R-ot.0 ... R.0.0.tex .... $.e W -.P- r ---- sex-VICe. ------------ ----------------------------------------------- Phone ----- Ro ... 5.n2j61_6-___ Installation, will serve: Residence [X Apartment House [-] Commercial E] Trailer Court E] Motel [] Other [3 Number of living units: --I--- Number of bedrooms --__-3 Number of baths 1__.-_ Lot size _-_Z-5.'-__X---135.t--------------------------_- i I Water --7-5-1---X ---135. ........... ----------------- Water Supply: Public system ❑ Community system X] Private Ej Depth to Wafer Table _A,5_ ff. Character of soil to a depth of 3 feet: Sand F] Gravel Sandy Loam El Clay Loam E] Clay E] Adobe [M Hardpan C] Previous Application Made: Yes Ej No Fx] New Construction: Ye!XE] ,,No Ej FHA/VA: Yes X] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ---- XX ------- Distance from foundation.._ 1Q..__ -__--.Material-. CC --- BT-LeA ------------- ------ No. of compartments ---- 2 ------------------- Size ------ -56 --- X --- 4'-Q_,__.Li.quicl depth__+j ------------------`Capacity.... Disposal Field: Distance from nearest well ---- XX ------- Distance from foundation ---._1.p '' _Distance to nearest lot line --- Number of lines ------- 2 ------------------------- Length of each line ------ 7_� t ---------------- Width of trench ---- 2-4.1' ---------- ------------ eb Type of filter material --.-1_!. �r_o_c_kDepth of filter material---__-_- ---- Total length --1-5-0-i ------------------------------ (> Seepage Pit: Distance to nearest well_ ----- ?�?� ----------- Distance from foundation ------- �?P ...... Distance to nearest lot line__ - 5 ----------- b Number of pits___ 2 -------------- Lining material ----- ---- Size: Diameter-- 3�� 7. Max -.2-5-1 ----------- -- -- -- ----- -- -- - -- - .___Depth from nearest well_------- -------- Distance from foundation ------------------- Lining material._ -- ------ : ---------------- C Fsspool: Distance fi '4❑- 71 Size: Diameter------ - ------- -------------Depth.... )------------------- ----- --------_ Liquid Capacity ---------------------------- gals.,, Privy: Distance from nearest well___------ ------ --- ------------------ Distance from nearest building-__---._-.-- -_:'-_..-__. �..._� ❑ Distance uilding---------------------------Distance to nearest lot line------ ----- --- ----- ------- Remodeling and/or repairing (describe): ------- --------- Kew ------------------------------ ---------------------------------------------------------- ------------------------- I -------------- ! ------------- ------------------------------------------------------------------------------------------------------------------------- ------------------ -------------------------------------------------------------------------- -------- I ----------------------------------------------------------------------------------------------------------------- --------- -- ------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- I ----------------- 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 rules and regulations of the San Joaquin Local Health District. ------------- ----------------------- (Owner and/or Contractor) (Signed) ---------------------------------------- Roto --- Raate. We- -r ---- �:r- 9 ---------- --------------- - -------------_- ----------------- ---(Title) By: ...... ------------------------------------------------------ L26? �_e. :Oirl ------ "'(P-jot plan, showing size of lot, location of systep5Krelation' to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION -ACCEPTED BY ----------------------------- DATE- 3,4_6_0 ------------------ _/ ----------------------- -------------------------------------------------------------------------------- REVIE\�/El) BY - --------------------- DATE------ ----------------- ----------------- ----------------- B'LD I ------------------------------------------------ UI NG PERMIT ISSUED -------------------------------------------------------------- — -------------------------------------- DATE, ------ jafions and/or recommendations--------- -------------------------------------------------------------------- ------_-----_ ----------------------------------------------------------------- V, -- ---- _ ---------- - ----------------- - ----- -------------------------------------------------------------------- -------- ------ ---- ---------------------- -------------------- ---------------------------------- ------------- ---- -------------------------------------------------------- ---------------------------- ----------------------------- ----------------------------- - - ------------------- ----- -------------------------- -------------------- ----------- -------------------------------- -------------------------------- ---------------------------------------------------------- --------------------------------------------- c) ----- I -------- ---------- --------------------------------- FINAL INSPECTION BY:- - --- Date ------------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M Revised 8-'59 F.P.Co.