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V ' / <br /> / APPLICATION ��J <br /> FOR SANITATION PERMIT Permit N <br /> (Complete in Duplicate) Date Issuecf'___.L- <br /> A plica4ion is hereby made to the San Joaquin Local HealthDistrictfor 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 LOCAT ON...c _ <br /> 414 <br /> ---------- - ----- <br /> Phone.-- <br /> Owners Name------------_--- -- - - <br /> ----------- - --•-- - :Z_ __ <br /> - ----- ------- -------_-------------------- <br /> -- 134A <br /> Address----_--------------------------------- - --- <br /> __--_•-V,S- <br /> � <br /> -----•---------------•-- Phon ----- <br /> Contractor's <br /> ----- <br /> Contractor s Name--------------_____w�•--.aA& --- - <br /> Installation will serve: -Residence Apartment House [3 Commercial ❑ Trailer Court [I Motel El her [3 <br /> 1-- Number of baths _�_-- Lot size ___�-DISC----- <br /> Number of living units: __.J-- Number of bedrooms _ i -. <br /> Water Supply: " Public,system ❑ , Community system ❑ Private K Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ CIa Loam ElClay ❑ Adobe Hardpan [3 <br /> Previous Application Made: Yes ❑ No P4 New Construction: Yes ❑ No ❑` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: # <br /> (No septic tank or cesspool permitted if public sewer is available within 240 feet.) <br /> : .W - ...__.. ., .W..._ - v Material__ �0� <br /> Septic Tank: Distance from nearest wel /_�._____---__Distance from fo�dation_- - - - <br /> Size_ Liquid depth_ -- Capacity - <br /> No. of eompartments___________�a-- „ p <br /> Disposal Field: Distance from nearest welLef1--_------- <br /> Distancefrom faundation__y1?r____..-_Distance to nearest lot line.______..__ <br /> -_____ _._.Width of trench__A_. --'� <br /> Len th of each line�� ---- - -`---"" ----"------• <br /> Number o{ lines-__•__�-____- g <br /> f- --- �� Total len th__ _Q_ -----_ ---- <br /> Type of filter material__.yore- --- -- Depth of filter matenal-__._/ ------------ 9 <br /> O O'__.Distance to nearest lot kine--�-------- <br /> Seepage.Pit: Distance to nearest well-/PV fr m undation__,� ;. � �� Depth_ S'--_-__'-__.___-- 6 <br /> �- Size: Diameter__ _ .. . . _ <br /> Number of pits-`j__-________--Lining material _ <br /> s <br />� Cesspool: Distance from nearest well_________________Distance from. .oundation________..____.___.Lining material-------------------------------------- <br /> Cesspool: th- ==--------Liquid Capacity----------------------------gals. 91 <br /> I ❑ Size. Diameter----- ---------- ----------------- p <br /> 1 Distance from nearest vrelL------------------ - --------- ----Distance from nearest building_____-___._-.--------------------------- <br /> i Privy: " <br /> El <br /> Distance to nearest lot ine__------------------------------ --------- <br /> --------------"-------------------- <br /> 1p <br /> ibe= ----•----•--------- ---------••----------------------------------------------------- <br /> Remodeling and/or repairing (des cr <br /> ------------------- i <br /> --------------- <br /> ---------- --- ------------- ----------------------—-------------• the S <br /> I hereby cePOA_ <br /> I have prepared this application oand that the <br /> work <br /> HealltheDistrEc{n accordance with San Joaquin County <br /> ordinances, Statnd rules d re tions f qu (� <br /> ----- ------- ------------- --- ------------ <br /> Contractor) T <br /> (S� ned <br /> i9 )-•------------ u . . ---•- . -- <br /> - - <br /> -------------------- --" ---- ---------- <br /> -•-- buildings, c., can be placed on reverse side]. <br /> (Plot plan, 'showing size of lot, location of system in relat to wells, <br /> FOR DEPARTMENT USE ONLY <br /> ------------ -------------- <br /> ------------- <br /> DATE-------------'r - -�°'------ <br /> APPLICATION ACCEPTED BY-----,--------------------------------- ------ ----- DATE------------------------•----------------- -- <br /> - ---- ------ <br /> REVIEWED BY DAT <br /> recommendatio <br /> PERMIT ISSUED--------------------------------------- <br /> --------------------------------------------------- <br /> Alterations and/or recommendations:-_.___.__.__- __._._._.________--- -- <br /> ---------------- <br /> --------------------- <br /> --------------------------------------------------- <br /> -------------------- --------- " <br /> oe <br /> -Date--- ------�- <br /> FINAL INSPECTION BY--------=------------'✓---- ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 Sycamore Street 814 North "C" Streef <br /> 130 South American Street 300 Wast Oak Street Trac California <br /> Stockton, California Lodi, California Manteca, California Y <br /> ES-9-21x1 ; Revised W2100 <br />