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(�6.N_ APPLICATION FOR SANITATION :MIT Permit No. 1.171 1 (Complete in Duplicate) / This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549. L_CA,1 R--4 " ' ,JOB ADDRESS AND LOCATION-1-r-0, _Fix---10-----14o.L --- 6n1--t ------------•------------------------ Owner's Name-- --W, A,f AII---------------------------------------------------7---- -Z17----------------------------------------- Phone--- Address'.-- --- ........ �� '�=�'��+ ' Contractor's Name (t'^� ' d.f ' --'-5" E-�'5-�----------- '----•--,�----- -oo-��------------ -------------- Phone---SRM -•---------------- Installation will serve: 'Residence ❑ Apartmenf'House-❑ -Commercial"g 'Trailer Court []' 'Motel ❑' Otheg0 j 1 Number of living units: ---I---- Number of bedrooms ________ Number of baths -------- Lot size ---------------------------------- Water Supply Public system ❑ Community system ❑ Private [E Depth to Water Tableft. eRmqnr�l►�� jo - Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Appliclition Made: Yes ❑ No'X New Construction: Yes Qc No ❑ FHA/VA: Yes ❑ No [K i TYPE OF INSTALL'A�ION LAND SPECIFICATIONS: (No septic tank br.cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---�__ f__--_Distance from ® i foundation___!_0-- _--____-Material____.i ' -------------- 0 Ifs i t' .._.__size____dX3,_X_.5� Liquid depth____. 4-` -----------Capacity...No. of compartments__-__..._ � b-' Distance from foundti aon____„ ___-�-_.Distance to nearest lot line___ Disposal Field: Distance from nearest welL___�C Number of lines----------7---------------------Length of each line_____ Width of trench_.! `......................... Type of filter,materia1__R4_,r , Depth of filter material______1!�__...........Total length_____] .0_ 4-------------------- Seepage Pit: Distance to nearest 'well---- ..__!_---------Distance from foundation--------------------Distance to nearest lotine---------------_ ❑ Number of pi ------k�" Lining material-----------------------Size: Diameter-----------------------Depth------------------------------- Cesspool: Distance from nearer welf_'____i________Distance from foundation___----------------_Lining material/--------_.--.---___________________- ❑ Size:, Diameter---------- a`.•__ p "'_.____ •�----------------- Li uid Ca acit f els. De tai q Capacity g Privy: Distance from nearest 1411____~T_______________________________________Distance from nearest building..___- .__-________________._____.___. ❑ Distance to, dearest lot 'line------------------------------------------------------=--------------------------•-------- ----------------------------- \ Remodeling and/or re airin "(,Iescrib 9 / P 9 ) - * -x --------------------------------•--•-•------------=-------�-----------------------------------.------- ------------------------------------------------------- "------------------------------------------ - + _-� 1 Iop ---------------------------------------------------------- ------------------------------ ---- ---------------------------------------------------------------_ ---- :--- --. -------------------=----•----------------------------------------------------------------- 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 Je&g06'Local Health District. (Signed) -------------------------------------------------------------------------------Owner and/or Contractor) ' By:---------------------------------------------------------------------------------------------------------------------------- -------(Title)--------------------------------------------.. - ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -- ------------------------------------------------------ DATE----- 7 v ------------------- REVIEWEDBY -------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------- ------------- DATE--------------------------------------------- -------------- Alterationsand/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------------- - ---------------------------- ------•---------------------------------------- ------------------------------------------------------- -----------------------•-------------------------------------------------------------- ----------------------------------------------------- -- ------------------------ ----------- _,`------------- --------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY%.---- -- ----- ----------- Date--.----- --- � �-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT f30 South American Sire*+ 300 West Oak Streot 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.