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r /FqR OFFICE USE:. - ------------ ---------- --------------------------------- PLICATION FOR SANITATION PERMIT Permit No.-----------I---------------------------------------------- o...------------------------------------------------------ (Complete in Duplicate) Zd Date Issued _C.___/-�J--_ /1-3 _ -------------------- ------------- -----.-------------- This Permit Expires 1 Year From Date Issued_ _ Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta the work herein described. This application is made in compliance with Count Ordinance No. 5 9. JO$ ADDRESS A D LOCATION n'f� ; - "" " J--- � iAVXA, Owner's Name --- --------- ""vl-- -- ------- -----I,-/- j------------------- ----------- Phone----------------------------------- Address Address3 -------- ----------- `` �. - Contractor's Name---- -. --•-----•------- .-- ------------------------------------------------------------- Phone....---- ---_--------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of`bedrooms _3__ Number of baths __J__ Lot size __ "Z _f"S-__-_,/-------------------------- Water Supply: Public,.system ❑ Community syst ❑ `Private [�epth to Water Table / ft. i Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date;__-_`-----------------) No E�`New Construction: Yes 0--K ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 'i (No septic tank or cesspool permitted if public sewer is available within 200 feet.} 6 Septic Tank: Distance from nearest well-�._Q---,.__Distance from foundation_��______._.-__.Material__ ��_ _� -� �'- No. of compartments_.___-- _____________Size____ _X'S~ ____Liquid depth._._�j1.._--__-___-_Capacity________ Q_ Disposal field: Distance from nearest well_-_J7P___._-Distance from foundatign---- lot line 01 Width of trench2 `�___________________ --------------- 9 r -------- ., / ws Type of filter material`6_ �(----_-_Depth of filter materiai/4-`_.- Total length_1--.��___________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation____._._._-_...._-_.Distance to nearest lot line----_.------__-._ .}!/ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter----------------------.Depth---------------------_----------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material___._-__----_________-____-_______._. ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------_----Liquid Capacity------------------------------gals Privy: Distance from nearest well -_--___-.__ -------------________.__--____._--_Distance from nearest building____.________---_______________.__.___--. ❑ Distance to nearest lot line--------------------- ----------' Remodeling and/or repairing r(describe):___/`2/' /L------- 0 ----4 �J=='-----�/1lST A ------Q�----- ----------------------- j�l?lT[ nlr �--------�rJ r-�' LC1 iF Ta-__:_: _F-?!6_- : --sr.-� -----__ TQ moo_ -l�X------ I-r-------�3A�K-F!4�-------114 B __.FNX>__.-pF-- -.�t+t"_-+._-.--�`_ f m--- 1�� ------------------------------------------------------------ ------ 1 hereby certify that I have'prepared this ap licatio and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulation of the an Joa uin Local Health District. (Signed) ---- -- ----- t- --------- -s-==----- ===-=--------------------------------------------- Owner and/or Contractor By:---------------------------------------- ----------;- ------ --------- - ---------------------------------------------(Title)------------------------------------------ (Plot plan, showing size of lot, location of syst m to relatiorgn o wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------- -------------- -- -- DATE----- � r l / ------------------- REVIEWEDBY------------- ------------------- --------------------- DATE-------------------------------------------==--------------- BUILDING and/or- �` E} --------------------------------------- DATE---------------------------------------------------------- -- ---------------------------- ammendations:----------/—j �-� --- U.0 _ Lx_1�-----514_f r> f 15 - !� U ------W-Vic} � //��X19�1-�� h-5------ � �#' �-� -------==----------------------------------- 5 -Iccl.k[�1 SCo " "' 1 £+ - ......... s1`r-""teat� n/ } ------------ ---- -- I-----------►7--i-JR - ------ --- - - -- -- --------------------- --- --- -- - - - - -------------- ------- ------ ------------------------------------------- -- ----- -- ------ FINAL INSPECTi9 - --- ---------- ---------- A Date---- �_ ��' l� SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street ` 205 West 9th Streef Lodi, California Manteca,California Trac Stockton,California y,California ES 9 REVISED 6-59 3M 3-'63 F.P.CD.