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61 9 <br /> APPLICATION . FOR SANITATION PERMIT Permit No.,5------------------ <br /> (Complete in Duplicate) <br /> 1411, Date Issued XY -5 <br /> dApplication.is hereby made to the San Joaquin �1 <br /> Local alth District for a permit to construct and install the work herein described. <br /> �1 <br /> This application is made in compliance with Count, r linatTce No. 549. <br /> JOBADDRESS D L -------------------- ------------------- --- ---------------------------------------------------- ------ <br /> Owner's Name---- -.11.--- ----------- -----'-------=-------r---------------- ------------------------------- - -------- Phone---- -------------- --------- <br /> Address........ -_0.... -------- ----'---- ------ -------------------------------------------------------------------------------------------------------------------------------I--------- <br /> Contractor's Name- -------------------- -------- ------------------------------------------------- ------------ ---------------- ------------------------------ Phone----•---------- ------------------- <br /> Installation will serve: Residence Apartment House 0 'Commercial 0 TraiVr Court E] Motel E] Other E] <br /> j <br /> - <br /> Number of living units- umber of bedrooms -1 Number of baths __ V Lot size ---17--- ------------------------ ---\ <br /> Water Supply: Publictsystern, 'Community system'[] Private 0 De�p_th_tU"Waitei­ Table'!�Qft. <br /> F % <br /> Character of soil to a depth of 3 feet: Sand Grave[ E] Sandy L Clay Loam 0 Clay El Adobe Hardpan 0 <br /> I <br /> Previous Application Made: Yes 0 No ;�ONew Construction: Yeo;. "N, El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: j I <br /> 44 d if ip available within 200 feeti) <br /> (No septic tank or cesspool perml' e I c sewer j <br /> I- <br /> -Puq <br /> Septic nk: Distance from nearest we45_0_?V'L"�%sta*,njl 1 f ro m &,nclatl' la_nW�.a t4e ,aj---- ------- ----------- ------- <br /> ova, -------- <br /> t7---------- <br /> Rr No. of compartments------------- - -----�Size.�Wa---���iquicl drpfh ------------Capacity---------- - ------ <br /> is <br /> Dispo�61 Field: Distance from nearest ll!Zb6-------!Distance llfrom folunclation-1 - ------�fance to nearest lot line- <br /> Lj ------- <br /> T w I <br /> Number of lines Length of.each line______ -Width of french-______ --- -- <br /> epth of filter ma eria ----- <br /> See <br /> ----- <br /> Type of filter me, t --------t.Q--- -----Total length___.____ -- -- ------- <br /> 0 <br /> Distance to nearest --- -Vfr qjfoun&tio ------- ig�A We to e <br /> Seepa,Te Pit. t w pI---- 6stanc n___'�O_ D nearest lot e -- ------ j <br /> m erial. . ..... Diameter----46..... ----Depth--------- - - --------------- <br /> Number of pits--------- ____---Lining at Dic <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- <br /> ❑ S Deptk­-��______ I- --_-Liquid Capacity------z------- _g <br /> ---- -------gals. <br /> Privy: Distance from nearest well-----_-------- --------------------------------Distance from nearest building------------------------------------------ <br /> n Distance'to ---- -- <br /> nearest ilot,line-,-.— -- -- - ----------------------------------------- <br /> - - ------------ ------------------------------- ------ ----- ---- <br /> f -- --eli an orLpairi c",ibe�. ------------- ----- --- --- ------------- --- --------------------------- --------L-Jer---------- <br /> -----------*----------------- ---------- --- ----- <br /> ------------- ----------4__- _ <br /> ------------------------­-------- ---------------------- ------------------ -------------ey -------- <br /> "I, <br /> ---------------------- ------------------- <br /> A--- ---- --------- <br /> I hereby certify.�at I havepreparedthis ap tion nd that the work will be done in accordance with San Joaquin County <br /> h application <br /> J, <br /> ordinances, Sfafd-laws and m6s' and regulations of the an Joaquin Local Health District. <br /> (Signed --------------------r-----------------------------------------------------------------------------------_(Owner and/or Contractor) <br /> ------ --------- <br /> BYZ--------------------- --------------------------------------------------------------------------------------------------(Title)--------- ---------------------------------------------------- <br /> (Plot plan, showing size Of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPY- ED BY -------------- <br /> l�-- <br /> ----------------------------- ------- ---------------- -------------- DAT <br /> E <br /> ,�r_--_---------- --- ----------------------------- <br /> REVIEWED BY -Y- DATE <br /> BUILDING PERMIT ISSUED DATE--------t <br /> --------------------------------------------------------- <br /> Alterations and/or <br /> --- re--c-o---m--m- <br /> Adations. <br /> L-- --1 ---- ---- ---------------------------------------------------------------------------&-----------5--%- 6----------- <br /> ---------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------- <br /> - <br /> - <br /> ------------------- - <br /> 6 ile -------a-- , <br /> 3------------------- ----- f <br /> - - - ----------------- ---- - <br /> ------------------------- ---- ------- ------------ <br /> -------------------------D-id--u---- <br /> Date----------------------------- ------------------------------------------------ <br /> FINAL INSPECTION BY:.-------------------------------------------- _­---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North C" Stree+ <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10.52 Revised W-2100 <br />