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i`�p%h APPLICATION FOR SANITAJLOpE ' <br /> 1T Permit No. _A5-17- <br /> (Complete in Duplicate) <br /> Date Issued <br /> lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, <br /> p{ ;is is made in <br /> complian-ce with County Ordi nce N 5 9. <br /> tt <br /> JOB ADDRESS AN��ION_ -- - --------- - -�0,_�� <br /> -- ----- - ----- <br /> ---------------- <br /> Owner's Name----- - -0 , �11--------------------------- <br /> ---- -_----­-Address------ ------------------ ------- Phone <br /> -I- --------- --------- -- ----- 7-p/ZZ3 <br /> Contractor's Name---- ------------------------------------------- <br /> - -------------A-- -------------------------------------------- <br /> Installation will serve: Residence 'Apartment House [] I Phon <br /> Number of living units: __/---- Number of bedrooms ji [I Trailer Court EO] Motel Other <br /> umber of baths <br /> _1--- Lot size <br /> Water Supply: Public system J0 Co ---------------------_ <br /> ommunity system ❑ Private C] Depth to Water Table, ff. <br /> Character of soil to a depth of 3 feet.,. Sand El Gravel E] Sandy Loam [] Clay Loam E] Clay C1 Ad,W Hardpan dpan [] <br /> Previous Application Made: Yes X No 0 New Construction. YesK No Ej <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearestDistaVn(c from foundation 4 <br /> No. of,cimparfmenfs- � <br /> Sze.;- ----------.Mater' - <br /> - ----------- <br /> --- -----------­_ <br /> X,-�V...........Liquid depf --- ----C�pacify_ <br /> Disposal Field: Disfance-fro,m nearest well �tance from foundations --- -- -------- -stance to nearest lot i� <br /> N �ber of <br /> ..... ..---Length of each line------------------------------Width of french <br /> Seep�qe Type of filter material_ ------ 9 ...................... <br /> -----Depth of filter material -Total length-:----- ------- ------------------------- <br /> pit.- Distance to nearest well--- <br /> Number of pifs ---well- <br /> ---Distance from f ndafioi-------- --- I Distance to nearest lot I;ne-- <br /> K, -----/--------------Lining material Size: Dia eter---.-, e <br /> ?_I�esspool: I -4------ ,7 !" ____Dept i <br /> Distance from nearest Distance from foundation ------- ----------rLining material_______ 4---- ----CIE)- <br /> Size., Diameter-------I------------------------------Depth--------------- ----------------- <br /> Privy: Distance from nearest well --------------- ---------------------Liquid Capacify------------------------------------ <br /> - ---------- <br /> ....................................Distance from nearest buildin -------- <br /> 0 Distance to nearest lot line---- g --------- <br /> --------- - ................... <br /> -- --------- ...... <br /> --------------------------­-------------- --------- --- - ---- ----------------------- - <br /> Remodeling and/or repairing (clescribe)��4­0-�­- ----- <br /> ---------------- <br /> -------------------------- ---- ---- <br /> --------------------------------------------------------------- ------------------------------------- <br /> ----------I--- ---------------------------------------------------------------------------------- ---7-- > <br /> -------f <br /> ------------ ---------------------------------------------------------------------------------- <br /> hereby certify that I have prepared this application and f--------------7----------------- -­---------------------- ------------------------------ <br /> -------------------------------------------------------------------------- <br /> ordinances. St I d ales and I f. that the work will be done in accordance with San Joaquin County <br /> ' <br /> laws, lations of the San Joaquin Local Health District. <br /> (Signed)--_----- <br /> By: ---4L ------------------------I--------------------------------I---------- __(Owne nd/or Contractor) <br /> ----­ ----- <br /> 'r ---- - -- ----------------------------------------------------------------------(Title <br /> (Plot plan, showing size of t, location of system in relation to wells, buildings, etc., can be " cad on ever side). ­------------FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> R -------------------------------- ....EVIEWED BY ------------------ DATE <br /> 1.'- . -::------------------ ------- --------- 7---------------------- <br /> BUILDING PERMIT ISSUED <br /> . <br /> Alfer"aflons and/or recommendations:--_ <br /> ---------------------------------- J e-_ -------------------- -------------------- ------------- DATE.-.._.- <br /> ------------------------------------------ <br /> -- <br /> ------------------- -------------------- --------- I <br /> -------------- <br /> ------------- <br /> -----------------------------------------*---------------------------------------------------------------------- <br /> _. ..` k <br /> ----------------------------I----------- <br /> ------_---------------------- <br /> ------------------------------------------------------------------------- <br /> ----------------------------------------------- <br /> ---------------------------------------------------:------------------------------------- --------------------- <br /> -- --------------------- ------- -----------------I------------------------------------------------------------------------ - ------------ <br /> ------------------------------------------------- <br /> ------------------- <br /> ------------ ---------------- -------- -------------- <br /> - <br /> I...... <br /> INSPECTION BY: <br /> --- ----------------- <br /> ------ ---------------------- <br /> SAN JO UIN LOCAL HEALTH DISTRICT, <br /> 130 South American Stree+ <br /> 300 West Oak Sfreet 132 Sycarnor <br /> Sfoclion, California 0 Sfree'+ 614"North "C" Street <br /> Lodi, California Manteca, California <br /> Tracy, California i <br /> ES-9-2M 10-52 Revised W-2100 0 <br />