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V _? 117---- APPLICATION FOP, SANITATION PERMIT it No. (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her iw�t ribed. 14 This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND L .. ---------- --------------------------------- OC�ION. ----- Owner's Name-------Al ---------- ------------------------------------------------------------------------------------------------ ---------------------- - ----------- Address----------W-41 IVY----- —------------ ----------------------------------------------- yj�� --------- ------- Contractor's Name.____-- ... ---------- ------------------------------- Phone! Installation will serve: Residence tK Apartment House [] Commercial [-] Trailer Court o'el ❑ Other ❑ Number of bedrooms -1---- Number of baths --/-- Lot size -- --------- 64...... Number of living units: j Wafer Supply: Public system El Community system ED Private)K2 Depth to Water Table .460 ft. Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam ❑ Clay Loam [] Clay E] Adobe]a" Hardpan C1 Previous Application Made: Yes [] No`5;C New Construction-, Yes E] No FHA/VA: Yes E] N01!5� TYPE OF INSTALLATION AND SPECIFICATIONS: ,,,--INo septic tank or'cesspool permitted if public sewer is available within 200 feet.) c anl: Distance from nearest well-----------------Distance from lounclalion--------------------Material--------------------------------------------------jr No. of compartments-----------------------_Size--------------------------------Liquid depth--------------------------Capacity-----------------------5 Di sal ield: Distance from nearest well--_-------------Distance from foundatlon--------------------Distance to nearest lot line----_---------__.S Number of lines-----------------------------------Length of each Iine------------------------------Width of trench------------------.-------------_- J2 Type of filter material--------------------/----Depth of filter material----- --------`.-Total length--------------------------------------;_.1le epa e Pit:'� Distance to nearest well___12V_ ____Distance f foundation----- .......Distancq to nearest lot line---- j - e Number of pits.-------1-----------Lining material------;�MO_M6.Size: Dia eter---1.�_ _ ..------- .?Depfk____ a---- ----------------- 0, Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__----.--_ --------------_--------... ❑ aterial------------------------------------- 171 Size: Diameter--------------------------- --- ------Depth----------------------------------------------------Liquid Capacity----•-----------------------gals. Privy: Distance from nearest well--- k----------------------------------Distance fronearest building------------------------------------------ 171 Distance to nearest lot line----- ------------- --------- ---------------------------------------------------------------------------------------------------------------- Remodelin and or re airingdes ibe ..... .... . . .. . ...... ----- -------- ------- -- ----- - --- -------------- -- ------- ----------- ------- ------------------------ --------------------------------------------------------------------------- ------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------I---------------------------------------------- I hereby certify that I have epared this ap-latication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ru s nd regul ns� the Son Joaquin Local Health District. ------- (Signed)------------------------- -- ---- ------ - ----- (Owner and/or Contractor) By:----- ------------ --- - - - -- ------ --- ---- ---- ---------------------------------------------(Title)-------- --------------------------------------------(Title)-------- -------- (Plot plan, showing size of location of system in rel i n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-•-- Y....---------(--- ------------ -----•-=;------------------------------------- ----------------- DATE------::::::---- -"-1---------------------------- REVIEWEDBY------------------------------------------ -- -- - ------------------------------------------------------------------ DATE------ - U-- ------------------------------------- BUILDINGPERMIT ISSUED_------------------ - --------------------------- ---------------- DATE-----A-/------- Alterations ATE-----A-/-------Alterations and/or recommendations:---------------- --------------------------------------------------------------------------------------------------------------------------------------- ------------- -------- -------- 4C7�---------------- ------------ .......in...... ------------- ----------------------------- ------------------------------------ --- ------------------------- ------------------- -------------- ----------------- ------ - -------------- ---------- - -------------------------------------------------------------------- ------------------------------- -------------------------------------------------- --------------------------------------------------------------- � I I `-..-t ------------------Z - ,7t— — ----- "-_----- ---------FINAL INSPECTION BY:.--------- Date_----- ---- �AN - -------,�5—------s----,---- ----- 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 1-57 F,?-M