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------ <br /> tj9PA*PPLICATION FOP, SANITATION PERMIT <br /> Permit No-d <br /> (complete in Duplicate) Date Issued <br /> t for a permit to construct and install the work herein described. <br /> Application is hereb�y made to the San Joaquin Local Health District <br /> This application is made in compliance with County Ordinance No. 549. <br /> ------------------------------------------------------ <br /> OCATION---.50--a- - /-------7;------------ Phone----4 ---------- <br /> JOB ADDRESS AND L A-�*---------------------------------- <br /> el--7-7, ----------� ---------------_ ---------------------------------------- <br /> owner's Name----------------------------------V 12 --------------------------------------­-------- <br /> r.�5� -- -- --------------------- ----- 1 A7--------- <br /> Address----------------------------------------------- ------ ..... Phone----?7�f.4 <br /> Contractor's Name_________________""evl__ ---- T rail e r Court M tel 0 Other C3 <br /> installation will serve- Residence 0( Apartment House Ej Commercial 0 size, ----------- <br /> g units: J--- Number of bedrooms S---- Number of baths J--- Lot <br /> Number of living [] Private ❑[] Depth to Water Table ft. <br /> Water Supply: Public system X Community systemClay Lam [j Clay ❑ AdobeX Hardpan 0 <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel ❑Cj Sandy Loam [I N ;) ' <br /> Previous Application Made: Yes F1 No1)E0.__ New Construction: Yes E] No 0 NrA" <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: available within 200 feet.) <br /> (No septic tank or cesspool permitted.if public sewer is av r .M a f e r i a I ---------------- <br /> f I d j1priS-------------- 40-4. <br /> Distance from nearest well Distance rorn ouS-!44-9------- <br /> Septic Tank: Size-Q-1- 3Z_Liquid de thou -------------Capacity_- - <br /> No. of compartments-----a'----------------- to nearest lot line-----2!;F7_' <br /> NIL nearest well rn�rrL ndat'ion__5f-_""""-Distance -------- <br /> Distance from n from U -----------Width of trench__!!;;�V-`0' <br /> Disposal Field: Number of hues"_"--/--------- --- Length of each line-_ <br /> 7-40-!n-----I _Tota� length-__0�_1P__1 ---- CrA <br /> ot Type of filter material"-- -----Depth of filter material - -------- <br /> f dation"__ <br /> 8.............Distance to nearest lot ihe90777 <br /> nearest well f ------------------ <br /> ge Pit: Distance to n ---------------- I�ro Size- Diame1er_­ 'V-------Depth--/4 ------ <br /> Seepa Number of pits--------I------- ----Lining material -1ining material-------------------------------------- <br /> m nearest well 6 from foundation_-- Liquid Capacity. - .-------gals' <br /> Cesspool: Distance from -----------------Distaric' -----Size. Diameter--------------------------------------Depth------------------------------------------------ <br /> ElDisfanc6-4rorn-nearest building------- -------------------- - <br /> Distance from' -well: ---------------:-------------------- ------- <br /> nearist - -------- - -------------------------------------------------------- <br /> Privy.. Distance to nearest lot line-_"_-.---------------------------------------------------------------I-------- <br /> 0 -------------------------------------------- <br /> Remodeling and/ repairing (describe):-------------------------------------------------------------------------------------- ---------------------- <br /> ----------------------------------------------------------------------"-""""-----•----------------------------------- <br /> ----------­-----------_---------------------------------------------------------I---------------------- -------------------------------------------- ------ ----------------------------------- <br /> ---------------------------------­ -------I----------------- <br /> --------------------------------------------------------------------------------- I------------------------------------------------------------------- <br /> ------------------------------------------------------------------ in County <br /> with San Joaqu. <br /> -------- ---------- ------ ---- <br /> ------- -I__hereby- -.__certify_that.-I__have prepared this application and that the work will be done in accordance <br /> I Health District <br /> ordinances, aw�, and ulesand regulations of the San Joa oca I <br /> State I 1� oc' Contractor) <br /> _4------- <br /> (Signed) <br /> f-- -------------------------------------------------------------(Tifle)--- <br /> --- size if system <br /> ------ ---------14-1------------ <br /> By(------- -- ---- - - ----- buildings, etc., can be placed on reverse side). <br /> of lot, location ofin relation to wells, <br /> (plot plan. sh — FOR DEPARTMENT USE ONLY <br /> DATE�--------A�- -------- <br /> APPLICATION ACCEPTED BY------------------- ---------------------- DATE----------------------------------------------------------- <br /> REVIEWEDBY--------------------------------------------- ------------------------- ------------ ------------- ------------------------ DATE------------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- <br /> Alterations and/or recommondaffor s:----------------------------------------------------------------- <br /> ------------------------------------ --------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------ ------------------- ------------------------------------------------------------------------------------------ ------ <br /> ----------------------- ----------- ------------- ---------------------------------------------- <br /> ----------------------------------------------------- - --------------------------------------------------------------------- ----------- --------------- ------ <br /> ----------------------------- -------------------I--------------------------- ----------------- ---------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------I------------------------------- <br /> - ------------- <br /> FINAL INSPECTION BY:-------- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 Sycamore Street 814 North "C" Sir"+ <br /> 130 South American Street 300 West Oak Street Manteca, California Tracy, California <br /> stoc"on, California Lo.di, California <br /> ES-9-2M B-51 Revised W-2100 <br />