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— <br /> Q, • APPLICATION FOR SANITATION PERMIT I Permit No. .1 S -5 1� <br /> ..................- <br /> (Complete in Duplicate) Date Issued --- 24/q <br /> A <br /> �plica-�ion is hereby made to the San Joaquin Local Health District for a permito construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND-LOCATION-- --- <br /> - <br /> Owner's Name---------lames--_--- ------------------ - -- ------------------------------------ Phone--- <br /> Address------------ -------------------------------------- -----------------------*----------------- ------- -- <br /> ----------- <br /> Contractor's Name------------3_� , ..& ---------- Phone. _ _'__ <br /> Installation will serve: Residence E�Aparfmen+ House ❑ Commercial ❑ Trailer Court E] Motel E] Other 0 <br /> Number of living units: --/-- Number of bedrooms M_ <br /> _3.. Number of baths /--- Lot size 1619-'-'_K_1��X ----------------- <br /> Water Supply: Public system 0 Community system El Private 2-"Depfh to Wafer Table442)ff. <br /> Character of soil to a depth of 3 foe+:' Sand 0 Gravel 0 Sandy Loam P?<51ay Loam E] Clay E] Adobe E—Hardpan ❑ <br /> Previous Application Made: Yes ZrNo E] New Construction: Yes Ej No E] 7 170 5-113 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sep-M Tai Distance from nearest well________________Distance from foundation___-__--_-_----_ Material-----------______..___------------.----__-__-_. <br /> No. of compartments- -------- ---------------Size--------------------------------Liquid dep+h--------------------------Capacity-------------------- <br /> -- 1 <br /> Dis$7sal <br /> apacity-------------------- -- <br /> Dis$7sal Fifid: Distance from nearest well-................Distance from foundation-----------.-------.Distance to nearest lot line----------------- <br /> (,R,px" Number of iines-----------------------------------Length of each line-----------------------------.Width of trench----------------------------------- `� <br /> Type <br /> rench------------------------------------ <br /> Type of filter material-------------------------Depth of filter material--------------- ----Totai length---.----.----------.--.___----------______ <br /> Se a e <br /> engfh------------------------------------ <br /> SeA!yqPit: Distance to nearest well-/d&----Distancedromfoundafion-/10...........Distance to nearest-lot.lin_e_4 -—-------- <br /> d-U Number of pits..--/--------------Lining material- Size: Diameter._-----------Dept <br /> Cesspool: Distance from nearest well-----------------Distance from foundation - -- --- --------- Lining material------------------------------------- <br /> El Size: Diameter--------------------- ----------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--_--_-___-----------------------------. <br /> ❑ <br /> uilding---------- ------------------------------ <br /> Ell Distance to nearest lot line------------------_---- --- ----------------- ------------------------------------------------------------------------------- ------------- <br /> Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------1------------------------------------------------------------------I-------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------I------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ---. <br /> --------- <br /> DAY A N1,07 <br /> Signed)�___ -----iYU-So. Eldorado NO 2-7046 --------- --- --A/--------------------------------- <br /> Contractor) <br /> (Title)By - - ---------­------ f-------------------------------- <br /> (Plot plan, showing size of l;t"JZaei( system in relation ---/. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- ---------------- ---------------------------------------- DATE------------ <br /> REVIEWED BY------------------------------------ ------- ---- ------ ------------ --------- -------------------------------------- DATE------------ --- --------------- <br /> _7 <br /> BUILDING PERMIT ISSUED-------------------- - ---------------------------- ------------ ---------------------------------- DATE <br /> Alterations and/or recommendations:---------------------------------------------- -------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------- ------------------------------------ ------------------------------------------------------------------­--------- <br /> --------------------------------------------------- - ----------------- -------------------------------------------------------------------------------------------------------------------------------------------------­ <br /> -------------1-----I------------------------------------------------------------- --------------------------------------------------------------------------------------------------- - ------ ----------------------- <br /> - ---------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY,,r_ �_ ------------------------ <br /> -_ r.-4{7--------I----------------------------------------------- <br /> SAN JO,AQUIN LOCAL HEALTH DISTRICT <br /> f30 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised W-2100 <br />