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14 <br /> APPLICATION FOR SANITATION PERMIT lie,16No. <br /> 1t <br /> (Complete in Duplicate) 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 MID LOCATIONA- 1 -------�Z4,lyz- ------------------------------- <br /> ----1-7f- <br /> Owner's Na,,,�__ VA__//,5 —------------7--------------------------------------------------------------- Phone------------------------------------ <br /> Address <br /> hone------------------------------------ <br /> Address------------------------ _-_7------------------------------------------- -------------------------------------------------------------------------------------------------------- -------------------- <br /> 4 - <br /> 7 �7--- ------- <br /> Contractor's Nam --------------------------------------------------- -- Pho:n <br /> Installation will serve. Residence ❑ Apartment House [:] Commercial' E] Trailer Court E] Motel,[:] Other X�4114_ <br /> 4r <br /> Number of living units: -- Number of bedrooms _: --_Nurrib`er of baths _;V_ Lot size __ _�447---_X -____ <br /> _________________ <br /> Water Supply: Public system El Community system C1 Private x Depth to Wafer Table ff. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel [] Sandy Loam [] Clay Loam.C] Clay [] Adobe A Hardpan ❑ <br /> ry <br /> Previous Application Made: Yes Ej No New Construction: Yes E] 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 we1_-----------.--Distance from foundation-------_----------Material------------------------------------------------ <br /> El N8.•,of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity-------------------- <br /> Disposal-Field Disf6nce from nearest well/40-0--.-Ditfance from fcunclaflon__,,,�--------.-Distance to nearest lot <br /> Number of lines _A749 -Width of trench ------------------ <br /> p ------ ------ <br /> Ty e of filter material/,/ -------- <br /> -e--------Depth of filter mate ---------------------- <br /> & <br /> -Length of each line <br /> a .-.,---Total <br /> J* <br /> $eeWe Pit: Distance to nearest welliozoa-------Distance-frorn foundafi6nlee­--- to nearest lot line-ZI-4 --- <br /> Number of pifs_61VE---------Lining material_ Size. Diameter. ------DepA___.-0W---- <br /> Cesspool: Distance fromnearest well_________________Distance from foundation------------___...Lining material_-_-.__ _-__---___._._____-.._..._- <br /> ❑ <br /> aterial-------- ---------------------------El Size:. Diameter----------------m.m--------m----------Depth----------------------------------------------------Liquid- Capacity----------------------------gals. <br /> Privy: _."Diitance from nearest well_----------------------------------------------Distance from nearest building------------------------------:----------- <br /> ElDistance to nearest lot line-----------.---------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)- -------- -------_______r______- ------I----------- <br /> ----------- ------------------- <br /> -------------------------- .4 <br /> --------------------- lev------ -------- <br /> -----------------------1---------- ---••------------------ --­---------------- -------------------------------------------------------------- <br /> ----------------------------------------------------------- <br /> ------------------------------M----------------------------------------------------_------------M---------------------------M--------------------------------------------------------------------------------------------- <br /> i <br /> I hereby Spdify-44t I have prepared this application and that the work wlll be done in accordance with San Joaquin County <br /> 7 <br /> ordinances ate laws, nd rulps. ons of the San Joaquin Local Health District. <br /> W " regulations <br /> (Signed)--------- --------" /j ---------------------------r___ zez----------------------- wrief 210or Contractor) <br /> - ------- --- ----(0 Pr a <br /> BY' t_1---------(Title(Title)------- <br /> --------------- -------------- --- ----- -------------------- <br /> rse s <br /> (Plot plan f�ot. location of system in <br /> g size o relafion +o' ells, buildings, etc., can be pld'ce on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- ----- -------------------------------- ---- DATE m_/__O_=__o�j� <br /> REVIEWEDBY--------------------------------------------------------- -------------------------------------------------------------------- DATE--------- --------------M-M---BUILDING PERMIT ISSUED---------------------- ------------------------------------- ---------------------------------------- DATE---------------------------- - ---- <br /> Alterations <br /> ATE----------------------------------------------------------- <br /> Alterations and/or recommendation' <br /> --- ----- - - - -------- - --------- - k------------------M ------ <br /> ------- <br /> - <br /> -- ----- ------------------------------ ----------- <br /> --------------------------------------------------- <br /> -------------I----->' - -- ----- fr---------------- <br /> ---------------- -- - -- -------- <br /> ... .... -- -- -------- --------- <br /> -- ------ -------------------------------------------------- <br /> - <br /> - <br /> --_-------- - -: -- -------- ---------- ----- --------- <br /> ------ -- - - <br /> - . <br /> FINAL INSPECTIONY:---------- , -- D&e__ - -- --- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American SfreL <br /> -f 4 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> I. ES-9-2M 8-51 Revised W-2100 <br />