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APPLICATION FOR SANITATION PERMIT Permit No. .__.1_!. (Complete in Duplicate) Date Issued --q7-3i.----(01 9 . This Permit Expires I Year From Date Issued 1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in- cmpliance with.County Ordinance No. 549. -------------------------- JOB ADDRESS AND LOCATION------------------ -�t---sa.l-- Rw-y-- _99---¢n---Goi---P-�---Pow#-.-Ro-ad gd3 Loyd Anderson ; ---------------------------- - -------�------------� Phone----------------------------------- Address-_..------------ ----------B. 2--5-+----Adel-k-e-Ct------------------------------------------------------------------------- Rooter--. _ ---- -p_T ----- -------------------------------- Phone----0----5--2-616 Contractor's Name_ RotQ w ce ------------------------ Installation serve: Residence T] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -----1 Number of bedrooms -----a Number of baths -1------ Lot size ------.- �----.--Y------------------------------------ I Water,Supply: Public syste' m U Community system ❑ Private ❑ Depth to Water Table --45_ ft. Character of soil to a depth of 3 fee+: Sand E] Gravel ElSandy Loam ® Clay Loam Clay E] Adobe C] Hardpan Previous Application Made:j Yes ❑ No [�] New Construction: Yes ] No ❑ FHA/VA: Yes ] No ❑ TYPE OF INSTALLATION.AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic iTank: Distance from nearest well-----..-_-`,ZQ-'Distance from foundation-1-V---------Material------.--cc..-fide Lok--------------- L] No. of;compartments-2--------------------Size---cJf��-b-__y---4-Qti---Liquid depth-----4 -�- -----.----.Capacit�c�]E-XZ)C---$0 Disposal Field: Distance from nearesfi weliE_ - Q-'------Distance from foundation-----1.p-1-------Di ce to nearest lot line-__&_!_ .. . � Numbe r of lines---- -----------------------Length of each line---•-- -�_-� - idth of trench.------ '*---------- =-- Type of filter material -�_-j5 --_r,".k__Depth of filter material-----1_g-----------Total length_---- �____',��►�'---------- J Seepage Pit: Distance to nearestV. --_----100-'Distance from foundation----1Q!-_-._,-.Distance to nearest lot line---5-1-----_-.. � Number of.pits -- ..Lining material- � ______--_Size: Diameter------- '•.______..Depth_.._.--��-f________________-- f Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining materia------------------------------------- e ❑ Size: Diameter------------------------------ -------Depth----------------------------------------------------Liquid Capacity----------------------------gals. --Distance from nearest buildin Privy: Distance from newest'well 9 ----------------- ❑ Distance to nearest lot line---------------------------- -- ------- --------------------------------- ----------------------------------- Remodeling and/or repairing (describe)----- ---------;_ew-- ePUC-•--s-y_-5-t_eM--------------------•----------.-...----------------------------------------- ---... IN --•---- -----------_------•-------------�- `'l --------------------------------------------- ----------- ------------- ------------ - --- - -- - --------------- ------- ---------- — ------- ------ — --------------- ------------------------------ --- ------------------------------------------ ----------------- * lication and that the work will be done in accordance with San Joaquin County I hereby Certify that I have prepared this app ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. .--.---.(Owner and/or Contractor) (Signed) Ao-t-0---Route-r----S-ew-er---Se-r-v- ------ ------------------------------------------------ fyjy� --------- - --------(Title)------PIN n_e_r------ ----------------- - -------------- (Plo+ plan, showing size of , locati n of system in relation +o we uildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------T7AK-Q-`----------- ---------------------------------------_------------------ DATE------fir ------------------------------------------ ---- -• DATE------------------------------------------ RI=VIEWED BY----------- ----•----------------------- ----- --------------- ----------- ---------------------•---------- '- - -----------•- ---- BUILDINGPERMIT ISSUED-------------- ---- --------------------------- DATE----------------------------------- ------------------------ Alterations ---------------------Alterations and/or recommendations----------- ----------------I- --- ------------------------- ------------------------------------------ -------- ----------;------------------------------------ ----------------------------------------------- ----------------------------------------------------•-I----------------- - -------------------------- I -- -------------------------------------------------------------------- k .n'n ---__-.------- ------------n------------------- - - ...... ........." FINAL INSPECTION BY:_._.- ld rr --------------- Date--- !-"--'------- ---------- - -------------------------------- II SAN JOAQUIN-LOCAL HEALTH DISTRICT --- 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreaf Stockton, California Lodi, California . Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co,