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' <br /> APPLICATION- FOR SANITATION PERMIT Permit No. <br /> � ~ <br /> ~ ~ (Complete in Duplicate) = ~ � 116te |oouw6 ^-------'-,�'0 <br /> -This l <br /> App|ic�xon is hereby made to the San Joaquin Local Hso|}h District for m permit to construct and install the work herein described. <br /> This application is made in compliance with County <br /> ' ` <br /> ~"~ ^`~~.`^~~ '..~ .~`. �­- Phone----------------------_----------- <br /> Address <br /> -'_--' <br /> '"^" e^�_13-^_1_~.. -.-_-_--'''-----____---_----.-_-.. <br /> Contractor's Nome-----. ----------------- ------------------------------------------ <br /> Phone----------------------------------- <br /> � <br /> Installation ,ill serve. Residence E] Apartment House 0 Commercial E] Trailer Court F] Motel [3 Other El � <br /> ' <br /> Number of living units: J-.- Number ofbedrooms -R Number of baths .j_' Lot size _��9 ------------------------------- <br /> ` <br /> Wafer Supply. public system 93-Community system 171 Private R Depth to Water Table .q- ff. <br /> Character of soil toadepth of 3 feet: Sand E] Gravel El Sandy Loam [] Clay Loam . C|uyE] Adobe JR--Flardpan � <br /> Previous Application Made: Ufyeo'do,n---- ---------) NoR]-'~1NewConstruction: Yo, [] FHA/VA. Yes E] NoE�----- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: � <br /> (No septic tank o, cesspool permitted ifpublic sewer is available within 200 feet.) <br />' Sept' Tank- ' Distance from nearest woU_-----Distance from foundation---_----WutoriuL--------_------- <br /> No. ofcompartments--.----_-..Size-------.---._'�qui6 depth_-------..Copocih'.-------. <br /> - ~ v �°-"� ' <br /> D�o | da <br /> o|6� Distance noo,o, well����-.-Distance from foundation--�^�-_'D|sfanco to nearest lot , <br /> '''- of filter- '-- ' -- <br /> - ' -���'---,- of filter- material---/-,-_* <br /> - '--'- -------'- - <br /> - -~- --' - ' ' <br /> , <br /> ~ S$epago Pit: Distance to nearest w"U�------''''Distance '- ' to nearest lot line'/�~/------ <br /> Number of pits---_-I--.Lining material----.. be: Diunril6tor--- Depth --2.47-.---. �� <br />� Cesspool: ' D�r nca-6nm nearest wo|L-'--''Di�anca �om foun6u�on-'''-''-L�ing motnhoi''-'-'-'-'--'-- ^~~ _ <br /> [] Size: Diameter-_-�'--''_'---Depth--'---''-_.''-'�--_-_'Uqui6 CapucHy..__-_-_-gals. <br /> -~~- <br /> � <br /> Privy: Dis�toncofromwell-------------- ----------------------------------Dis+*ncefrom nearest building'--'_-'--_---_-'- � <br /> F1 Distance to nearest lot line---------------------------------- .....---''''-'''-'-'---'-_---' <br /> ~, ` <br /> Remodeling and/or repairing (describe);--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> _-'__-___=�--''-_�__''--'-_.''__.-_---_.''----_---_.''---'''----_'-'--_-__.�-''-''-''---__ j <br /> '------''��-'--�'----'--'----'---------'---------------''-------'�=`�=�=�-'--------- <br /> - \ <br /> -------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I hth6 work will be done in accordancewith San Joaquin County <br /> State <br /> ordinances, . \ � <br /> ^ � <br /> -- - ---------------------------/--- ------ ---------------------------------------------------------(Title)------------------------------------------- -------------------- <br /> (Plot plan, showing sh of lot, r1cation of system in relation to-w'ells. buildings, efc., can 6e placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- <br /> REVIEWED 8Y'-''�-^'-_''------'~��'---'--.--'----'-- --!- DA|�''-''''_'-''-_�-'--'_-.'- ' <br /> DU|UO|N<��PER��|T ISSUED_--.----..--._-_-�__._-'_--,L_-_^- DATE-------- ----------------------------------------------- -- <br /> Altn,mfionoand/or recommendations:--------------------------------- ______ i <br /> -''--------'---''----'-----'-----''---'' --^^ ----- ' ---------------------------- --------------'------ <br /> ---------------- -------------------- -----------------�--7'------------- <br /> 7-~�~-''-'-�'-°~--'---'''-''---'--�-'---`-'''---''--'''-'--'-'--''------'----''-'---'---- <br /> �_�_�����__�__���_��_����__�__�___�___��_��_��'_��_^---'--__�__---_---_---__---__---_---__��---_---------__----------- <br /> �N/\L |N�PE�T|[)N ''-�. ' Do+o--./. .�-��-��'�l -'''--'-- <br /> ~~, - <br /> ^~ SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak s*°° 1»^Sycamore Street cosWest 91hStreet � <br /> - <br /> � Stockton,California Lodi,California Manteca,California »acy,California <br /> � <br /> F~""=°""""."""^"0.""".= <br />