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' FOR OFFI <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------------------------------- <br />--------------------- 1 ' ----'----' (Complete in �~r^~�'~' � Date Issued <br /> Application is hereby made to the San Joaquin Local HomK6 District for and installthe work herein described. <br /> This ~� <br /> .4 <br /> . <br /> JOB 32 <br /> =^~ . <br /> Owner'sN � <br /> � <br /> C°".ra`~r's .""��. :�_'L-S-__-'_------------------------------.................... . ............ Phone............................. <br /> --' <br /> Installation will serve: Residence 2~ApadmonfHouse [] Commercial [3 Trailer Court [] Motel 0 Other C] <br /> Number ofliving units: J.... Number of 6w6,uomm ;-.. Nu,nbm, of baths -1- Lot size .....� -------- ............. <br /> Water Supply: Pu6||o system Erl-'Cnmmunify system 0 Private [] Depth to Water Table 6.0 ft. | <br /> | <br /> Character of *w@ to a 6mpf6 of 3 feet: Sand [] Gravel [] Sandy Loam [] Clay Loam [] Clay [] AdobeFF~F:Fardpmn [] / <br /> � <br /> Previous Application Made:m6�: V ------ P"" <br /> New) No U�' NewConstro�tion: Yes g�~"Im-o [] FRA/VA. Yes [I No F+--~ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:' <br /> (Nm septic tank or cesspool permitted if public sewer is availableMhho 200 ftJ <br /> Septic Tank: Distance from nearest Distance from foundation----K�� 'Mu+e,ia| <br /> lh�' No. ofcompartments-------2------..Size------ Liquid 6epfh-'_4------------------Cupuc|fy _��� w'~ <br /> D|s | a|d� Distance from nearest woU���-__Distance from foundution-Ju�_-- � <br /> .�D�otunoa h» ��mnostt <br /> Number ^ �� <br /> � Tvpo of filter muforiu| .--Depth of fi|for mo�orimL-..��k..�--To+u| |ongt`----��8�.---_--.--.. <br /> r _ ^ <br /> Seepage <br /> �~~~-R+: Distance to nooro, - --.? __ to nearest lot line----��--- <br /> / <br /> cu ' � ' ���Num6a, of p|fn �----Lining mmto,io| -'' eDium�+ar ~~ �-- Dept� ' � � ' <br /> , material. <br /> 4J � <br /> ���nca from nearest °mU_.----D�tanoyfnvm foundation mo+m�uL---'_''--'-- <br /> [] Size: Diameter-------------------------------------- -''---____'''''---'''__Liqu|6 ----------------------------gals. �] <br /> Privy: Distance from nearest well -._-- ----------------------------Distance from nearest building-_-'-'--_-_--- ~ ' <br /> 0 Distance hznearest lot line------------- ----------------------------------------------------------'-'''- -------- -.-----''-_------ � <br /> | <br /> Ramo6eing and/or repairing (dascrib4�):--------------------------------------------------------------------------------------------------------------------------------------- -__--_ <br /> -----------------------'-------'-'---------------------'---------'----'-----'---'-'-'------- <br /> --'—'------------'--'-''--'-----''------'-----'--''---'--------------------------' <br /> ------------------------------------------------- <br /> I hereby certify that I <br /> . <br /> hive prepared +hio application and that the work will be done in accordance with San Joaquin County ' <br /> ordinances, State laws, and rules andd*regulations f the San Joaquin Local Health District. <br /> By:---------- ............................ -- - -- ----------------- -/ <br /> vs <br /> (Plot plan, showing size of lot, location o, system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY � <br /> �� - ��'--'' '-'----- <br /> �� .��� ;U - »�� «�'�- ' <br /> '--'---''_-''''^_-�-''-''__''_''-''°''----''''-_--_'''-__-'---__.-____--'''---'''--.-^-**-- <br /> .—.__—'_-_------_-_--_----._--.-_----._---_-----._--'_____----_.—_---.. <br /> -------------------------------------------- ------------------ '''--''' ...... -''-''''---''-'''-''-............... <br /> ~� ��__ � <br /> F|N/\L (N5PEI�T|(]N BY�-.��' �����~~- Dafo--��---����`-��-�7-.-��--------- <br /> SA�� JOA��U|N LOCAL HEALTH DISTRICT <br /> /onSouth American St=et nwwWest Oak Street v12*Sycamore Street zpsWest 9th Street <br /> Stockton,California ' Lodi,California Manteca,California Tracy,California <br /> ** , "«,/"«" "°' °u °'°, m=" <br /> � ~ <br />