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FOR OFFICE USE: <br /> ----------- --------------- ----------- - -------------- APPLICATION FOR -SANITATION PERMIT Permit No. . 0_312 <br /> --------------------------- ------------- --------------- (Complete in Duplicate) ZVI;_�.a <br /> --------- This Permit Expires I Year From Date Issued ? V .4-3 <br /> licafion is hereby made to the San Joaquin Local Health Di <br /> strict for a permit to construct and init WorNereZaescribed. <br /> T71spapplication is made in compliance with C ty Ordinance No. 54?. CC?� 0 <br /> ~~~ '`~~'``~~ AND <br /> L CATION,59--- I'L-A-S.-JR-as <br /> Installation will serve: Residence <br /> ^~ Apartment House C] Commercial^ E] Trailer^ ~~^ '' mo °~."" F1 Other <br /> Numbar cf living un�s: Num6er of be6 --2-. Number of baths /_. Lot size <br /> Water Supply; Public system Community te [] Depth mWater Table .4_ ft. <br /> Character of mmx to m depth m*i feet: Sand eGiayp|�[] Sandy Lounn [] Clay Loam [] Clay [] Adobe[] Hardpan [] <br /> Previous Application Made: (if yes,6on». No R' New Construction: Yes E9~^No FHA/VA. Yes El No <br /> TYPE OfINSTALLATION AND SPEC|F|CAT|ONS,:� <br /> \ � <br /> (No ommfic tank or cesspool permitted if pm6k,swwer is available within 200 feef] <br /> . * <br /> Septic Tank: Distance from *e 50, ' �P <br /> m�~ Nunfuompurhnent�_--~� '—�_5 ��- L�u. 6onfk— — n —' <br /> Disposal Field: Distance from .-Distance from foundation ^0 <br /> 25__ Number of lines —Length ofauch ' <br /> Type of filter mmtohuL_�������—Doo� of filter ma+a�' ------ ^-----Total �mo�---- .� —._— <br /> Seepage PM: Distance to nearest ~e| Distance fro X � <br /> [] Number of pit,' Linmaterial------------------------ Diameter —''Daot6-''—''—_.'_—'_ '^ <br /> Cesspool, Distance from neony� v�L—__-D�funcafrom ' ----- --------------Lining material --_---__—' <br /> [] Size: Diameter--- -----------------------------------------------------Liquid Capacity----------------------------gals, 6 <br /> Privy: Distance from nearest well--------------------------------------- . —'Dis+uoca from nearest building---------------------------- ---------- <br /> L] Distance to nnon,`+ lot line---------.------------_-...—.__—_-----..^-'-----_-------� <br /> Remodeling and/or repairing (describe):-- ------------------------------------------------------ ----------------------........_ ................... <br /> -------------- ------------------------------------------------------------------------------_.~_----_-_-- ---------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------- ---.--___. -----------------------------------_'---------------------------------------- --.._—. ---------------------------------- <br /> '--'—'--'—'--'-----'-----'—'' <br /> I hereby certify that I have prepared ihis'applicafion 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 /> ---------R�� ------ ----- _.___________--- ---------------------------(Owner and/or ' <br /> By;-------------------------------- --------------------------------------------_ — - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 69 placed on reverse side). ' <br /> FOR DEPARTMENT USE ONLY <br /> '_—_--._--_-------..__--------._'_--'__----_--.___.------_--.—__------____—_. <br /> —'''---'''---'''---''--'''—'''''--''---'''''--''''--''-''---'-''--------''--'''''—'---''--'--- <br /> '----'' '—_.—''---''—_—''—'''--'--''_''--'----'- <br /> -_'--'' ------------------- -----------1,—''­--.^_---�--'''''_'''--''—''---- <br /> ' ��- <br /> FINAL |N3P .L�.,./ .. _ Dote-------- <br /> SAN JOAQUIN <br /> __.SAWJOAQU/N LOCAL HEALTH DISTRICT <br /> 130 South American Street oowWest Oak Street ,r4mvcam"=Street owsWest 9th street <br /> Stockton,California Lodi,California ~~ - ~ ma"te"".Caofo,"/n rra:v'California <br /> co 9 ncv/mcn o'np zm 5'6u ATLAS <br />