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s� � <br /> APPLICATION FOR SANITATION PERMIT Permit No.�.'f�__. <br /> 5 <br /> (Complete in Duplicate) � <br /> a, Date Issued � <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> } JOB ADDRESS AND LOCATION----- 7—-----.f-777--------------------------.------------------------------------------------- <br /> Owner's <br /> - - - <br /> Owner's Name- _. 1.0-f9-1/-Q-----. ----------------------------------------- ------------------------------------------------------------------------------ Phone__ _'_ __ a ------- <br /> p � f' <br /> Address-----------------17-f/-,; ......6 5 _-` 27--------------------------------- • •- •-- - <br /> Contractor's Name---a_3 .----.tom fa'_/ 'f - ----rla- ,16X----/A_/h------------------------•-------------------- Phone--- ------ <br /> Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ElNumber of bedrooms .- -_ Number of baths <br /> Number of living units: ._: <br /> ,� � -Z-- Lot size ----�-f%---- --- <br /> - � ----------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 0- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe L2?-__H_ardpan ❑ tA <br /> w Previous Application Made: Yes ❑ No New Construction: Yes No ❑ <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 nearest well-L/_Q_A1Cc__Distance from foundation----/49-----------Material /CA'...... <br /> No, of compartments------0----------------Size/&.?�X_42�* Liquid depth-----J~--------------Capacity., FQei,___ <br /> Disposal Field: Distance fromi nearest well_/_0?Ae7C-_.Distance from foundation-__40..........Distance to nearest lot line__,_vtt_`_--- <br /> W__ Number of fines----___-/__-----_ ___.__________Length of each line___----/40_��.------.Width of trench------Z6.'---------------- <br /> Type of filter material>�'�'----��,�__Depth of filter material----,2___.--------Total length--------ZQ0----------------------_ <br /> Seepage Pit: Distance to nearest well- _e_G''_.--_---._Distance from foundation__,ZP__/__=__.Distance to nearest lot <br /> Number of piig_____/--------------Lining material-$W/+GA-----Size: Diameter----s_'r0."-------Dept h-__-_Z_t*-_.*-.--_--__-_--.- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- Lining <br /> r material----__._-----_-_-_----_______-___--_ <br /> ❑ Size: Diameter----------------------------�- --_De th----------------------------------------- ---_Li Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-.------_ -----------------------Distance from nearest building----__-----_-___-__-_______----_-_--_.__. <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------- --------------------------------------------- <br /> Remodeling <br /> ------------------------------------------ <br /> i ,/ .---- <br /> Remodeling and/or repairing (describe}:_-�f°Fll-----��_�_�_��-�-----------------------------------------------------------------•-•--------...-------- •-- <br /> { <br /> ---------------------- -------•---••----------------------.-------------------------------.------------------------------------------------------------•------------•------------------------------------------------ <br /> i <br /> -----------------------------•---------------------------............---......-..---------------------------------------------------------------------------------------•---:-----------------••---------------------------- <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 /> - ---- -----�J:- t C1 '4c--------------------------------------y----------------------{Owner and/or Contractor) <br /> c �� <br /> B � l -------------------------- {Title} t, /1�1Q. .- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, eta, can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. ------------------------ DATE- <br /> REVIEWED BY------------------ ------- - ------------------------------------------------ DATE _ <br /> BUILDING PERMIT ISSUED-------- ---------------------------------------------------------------------------------------- DATE------------- 91---+---------------------------------------- <br /> Alterations and/or recommendations---------- -----------------------------------------•---------------------------------------------------•-- ------• -------------------------- <br /> ti <br /> --------------------------------------------------------- -------------------------------------------------------------------------------------------------•----------------------------------------------------------------- <br /> 0 <br /> --------------------------------------•---------------------•---------------------------------------------- ----------------------------------•-----------------------------------------------•--­ ---•---------------- <br /> FINAL INSPECTION 8Y: W_0 �--- -'- <br /> .s ---- Date-------•------ --. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> , <br /> # ES-9-2M B-51 Revised W-2100 <br />