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1197... APPLICATION FOR SANITATION PERMIT Permit No. .... ...... (Complete in Duplicate) plc Date Issued 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 install the work herein described. This application is made in compliance with Coun Ordinance 5 9. ADDRESS ANAArt OC ION- I__.... ------ JOB !'! � Owner's Name...._._ ...�_.. ... Phone.................. Address.-------- --.................. ----------------•-----•----- ��y - ---- ..._... Contractor's Name....................... ........d�%�1�� ..._............................ Phone................................... Installation will serve: Residence ga"A"partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/_.. Number of bedrooms S Number of baths J.-• Lot size _- /- —-- - �---:--- . __.-______________ \ /iL i Water Supply: Public system E] Community system E] Private [:] Depth to Wafter Table ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel �andy Loam ❑ Clay Loam Clay❑ Adobe❑ Hardpan ❑ ZR Previous Application Made: Yes ❑ No [Er' New Construction: Yes gj--go ❑ FHA/VA: Yes ®/No ❑ O TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tar k: Distance from nearest well...._.__DistanciL rom foundation.._/Ap4..-----.Material_&_- .-_ ......... No. of compartments-_--1Z...... ..X.. Liquidr..-.._.._--Capacity_.- 449.... Disposal Field: Distance from nearest well.14-49-....Distance from foundatio /,P Distance to nearest lot line.._.__.. [ � Lo Number of lines Length of each line-__._f'64_-:.-_�i..._.Width of trench ._%' !.................. Type of filter material,l /k11 /CtDepth of filter material_... ._.......Total length__..._. � .................. C • � e Seepage Pit: Distance to nearest well../QQ_./..Distance from efo�undation....Xb#........D-st nce to nearest lot line,...Ar..... Number of pits..... .............Lining material_�0.fr�C..Size: Diameter.��0-------Depth... ...-.�a�_..._._ Cesspool: Distance from nearest well.................Distance from founds+ion....................Lining material...._......r��'L` ❑ Size: Diameter_-----------------------------------Depth:.:.-•-•------...................._................Liquid Capacity--------• .................gals. Privy: Distance from nearest well..............................:..................Distance from nearest building...........................___............ ❑ Distance to nearest lot line...........•-••------•................................... ....,.{.....-------------- �.. - Remodeling and/or repairing (describe}:_..._.__ �--—--- C_.•------------------------------•---•-------•-•----•--------••------ ...---•••-•--••--•.......................••-•-----•-•-•-•-------•-•._..--•-.........-•--...--•-••------•----••-•••-•-•-•--•-••••---•-•--......--------.....----••--•---•••------•----................_._...........-------� ....................---•••--••...........................................--•--------•-••---._...._._........--••-•-•----......---...._....•----..........---•--•--...........--------.---•-.--._----••--• --...... --------------•-................_.....--...................................•-•-----•--------•-•-----•-•---•---....------.---••----•••....._._..._..--..-••-•••----...-•-•••••-•-•--•-•----••.........-•---.........._..... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules an regulations of the San Joaquin Local Health District. ...-.•--. ------------------- -• Contractor (Signed) -----.----. ) -------------- By:............................................•--.........._ ... (Title).....---�TifJ�� 14, (Plot plan, showing s'ae of lot, location of s m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...........t._• _,..._-_ ...._.__. DATE.._..___._.- _/D•-.__ _D__________________ -----•----•-•--••--•-•--._.----••---•-- REVIEWEDBY..............................................--------------------------------------------------------------••--•--••------ DATE---......................................................... BUILDINGPERMIT ISSUED................................................--............-...................................... DATE............................................................ Alterations and/or recommendations:................................. -•--.•----f........................•-------------•-•._........._...--•-••--•-•----•.......•----..............; ......-----•--------------•-------------------------------._.....P117_... ....... ..........I ....... � s° .............................................................. .......... .... ....................••-•••...........................•---••-•••...----......_.....--••••---•••......----............; ......................................... ......... ...._.. . ......................................................•. .----•-....----_... ._•-• .. ...•................-•----•------------------------•-•--•-------••••-..._._.....•-------....._...........--••-•-•--.-•-•; FINAL INSP �.. ......... . .. ��! Date....... r _Y:7160...---.........._.........--••--. 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.