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~ � | <br />�� ~~ <br /> APPLICATION FOR SANITATION ����� ��� No. � <br /> '- -� <br /> (Complete�� � ��o�uDuplicate)��`�- Duplicate) � <br /> Du+v Issued ���'] ���� <br /> 6n the San-- -,,_—n - --_- in complianc- with County _...Septic . <br /> Installation will serve: Residence Apart ent Hous- F] Commercial F] Trailer Court F] Motel E] Other E] <br /> --- Number of baths -1--- Lot size <br /> Wafer Supply: Public system Community system E] Private [-] Depth to Water Table,,7.!�r-ft. <br /> Character of soil to a depth of 3 feet: Sand E] G t ravel Ej Sandy Lo I am 0 Clay Loam E] Clay E] Aclobw Hardpan L] <br /> Previous Application Made: Yes E] No) P< New Construction: Yes Noj'W <br /> TYPE�OF INSTALLATION AND SPECI(I'CATIONS <br /> (No septic tank or cesspool permitted if public sewer is available wi thin 200 feet.) <br /> Tank: Distance from neuros well-----------------Distance from foundation--------------------Material ------------------------_.'--''— <br /> EA . Np. of compartments------------------------- 5�o_---_------�qui6 dep�h-_--` --.Copn6t�_-----.. N^ <br /> D�pom| Ra|d�KDistance from nearest °eU------Distunoy from foundation--------------------Distance to nearest lot line------------ <br /> Number of lines �n� � m� ||� �� � ��� � <br /> -'''-'''-''--' ' '--��_'—_- '-�-'-'''''--'' <br /> Tvpe of filter material--,-',-.,- Depth of filter material- Total length- <br /> See e Pit: ' Dist,noa ^ Di rice to neo f lot line �� ^ ~ <br /> Number of p�o -'JL - .'- ning�m Diameter---,?..,--..�--Deo+6.. / - -.-------- <br /> : Distance from nearest well ''-----Distancafrom foundation---'''—Lining material ---'-''-'--'_'— <br /> [] Size: Diai�i6f&~�`''' ----------------------- '-'-'---'''':''''-_�'�-Liquid Capacity-'--''-''--'.ga|s ` <br /> Privy: D�dnnoe from nearest well -------------------------- ------ ------'Didnn»o from. nearest building------------------------------------- <br /> -- <br /> [] Distance tunuunei+ lot Sno------------------------------------------------------------------------------------ ---''-''______________. <br /> (describe):-- --_._-'.----.__-_---'-----_-._-_--.___._._.. t <br /> Remodeling and/or repairing <br /> --'---------------'-------------------------------------------------------''- ------------------------------------------------------------------------------------------------------------------------------- | <br /> ----'----------------------------------''---''-r--'------'------'------'-----'' | <br /> '- --------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- ------ | <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County. <br /> ordinances, State I W, an ru s and regipi4tions of the San Joaquin Local Health District. <br /> (Plot plan, s owing size of lot, location of system in relation to wells, buildings, etc., can be pl9d on reverse sid i. <br /> FOR DEPARTMENT USE'ONLY <br /> r`rruCr`//Om ACCEPTED BY " <br /> REV|EWBD BY <br /> 8U|LD|NG PERMIT ISSUED-_-- -�)--'_----_-_-_----._____—. DATE---- ------------------ <br /> Alterations <br /> --.--.—A|to,wtio?s and/or roowmm' mn6aions:......... ------ - ------ -------------------------------------------------------------------------------------------------------------------------------- <br /> ���-----------------------------;-----------­---- ------------ ----------------------------------'---`------------------------'���������------------------------------------_-­--­--'--------'' <br /> ' ' <br /> --'-''-'---''--''---'''--'---'''_-'---------------------------------------------------------- .'''-'''-'-'''_-''''----------------------------- ------ <br /> ° <br /> _'-'-'-'----_'''-'''_-''''-''''-'''-_'---'--'''--''--.'`-''''--'''_-'''-''''_--'--'---=,-''- <br /> —'-''-''-'---''--''--''''--'''--'--'---''--'--'''-'''--''--''''--'--'''''--''-''---''----- <br /> FINAL- !NSPECTK]N BY:.''....' '-- Du+e��� -''-'_'-'�^____ <br /> SANJDAQU|NLOCALHEALTH0DTRICJ <br /> 130 South American Street ' 300 West Oak Street /32 Sycamore Street owNorth 'C" Street <br /> Stockton. California Lod[ California M*nm*". California navv California <br /> � ~ <br /> \ w /o-52 Revised vv-2/00 <br />