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I
<br /> X yS
<br /> FOR OFFICE USE:
<br /> _
<br /> .................:............. APPLI' ATION
<br /> 3'gip..... FOR SANITATION PERMIT Permit -r:::-;: .->:. .'
<br /> .... .... ..... ... (Complete in lauplicate)
<br /> This p""mit Ex iris 1 Year From Date Issued /
<br /> Dnte Issued ...
<br /> jpplication is hereby -ado to the San Joaquin Local Health District for a permit to construct and install the work hntein
<br /> h.s applica;ion it made in compliance with County Ordinance No, 549,
<br /> described.
<br /> 08 ADDRESS A Loc ON...,
<br /> 3......•.£^ ..
<br /> )wner't Name ..............................
<br /> ..................................
<br /> ..........................................
<br /> ddress...G.3I
<br /> -ontracos Name...-.. .
<br /> ........ .........I...
<br /> .... ................... ........................... ...-.
<br /> Istallatfon will Serve: Residence A MOrC.......................Apartment House © Commercial ❑ Trailer Court E] Motel
<br /> Number of I' 'nry units: ../..•. Number of badrooms _ ❑ Other ❑
<br /> ,afar Supply: F Number of baths .�.... Lot size .. ,�
<br /> C system J�Cammunity System ❑ Private !/�
<br /> parader of soil to a depth of 3 feet: Sand ❑ Depth to Water Table GG. {t-
<br /> eriow 0 Gravel I] Sandy Loam(] Clay Loam[] Cley[� Adobu � ,
<br /> AppPicafian Mads: (if yes,dote. JCI Hardpan C]
<br /> (PE OF,INST I NO ❑ New Construction; Yes ❑ No FHA/VA; Yes [I No []
<br /> ALLJ1T10N AND SPECIFICATIONS:
<br /> (No septic tank or cesspool permiHod if public sewer is available within 200 feet.)
<br /> optic Tank: Distance from nearest wall,
<br /> e?_' P �'�+l�G.Qistence from foundation...f. .f Motorial .................... ... ....
<br /> No, of com artmenfs_. _ Size..............
<br /> • ..................Liquid depth......... .,..,.. ...,... Capacity.......... ......_.....
<br /> sposel Field: Distance from nearest jell.`..............Distance from foundafion..,.
<br /> s`trlyG Number of lines..._•_........ .. ............. . Length of each line...........l ,'••,•,_Distance to�e hest lot 1;50,,. ..
<br /> +QD¢ . Type of fitter metertal,�.{�p)rL ,J%�Depth of filter maferioLJ.,Sr�� Total fen `
<br /> :epage Pit: Distance to nearest well./.1!ON..1C.......Di:stance from foundatlon..L Z.•,,, 9 . 0....... ................'.
<br /> im Number of its..- istaye to nearest lot line.�r1
<br /> p Lining material- IX k� ..„Size; Diameter...
<br /> %spool. Distance from nearest well,................Distance from foundation.........•,•,_•,. „Lining material pth Z ...
<br /> ❑ Size: Diameter. ... .............. ................
<br /> Depth........:...:.....................................
<br /> ivy: Distance from nearest wall............... Uquid Capacity.................. W
<br /> .........gals.
<br /> ❑ Distance to nearest lot line........,. Distance from nearest building W
<br /> .modeling and/or repairing (doscribe):� •...................... ..... ................................................. . ....... .........
<br /> _........................................
<br /> Qlfs +l.�...................................
<br /> ..........
<br /> ..:...........
<br /> .........................
<br /> I herebcertify that I have prepared this ai of the Sanicaflon d that the work will be done in accord ance..with.San i...........
<br /> linavices, fate laws, and rules and 'eg
<br /> Joaquin Local Health District. oaqum County
<br /> C"LPAr'lc.Ci.. ......................................................... (Owner end/or Contractor)
<br /> 3tIan g ...................:...............................
<br /> • (Title) ........ ..............
<br /> Plan, in size of lot, to anon of
<br /> SYS in relation to wells, buildings, etc., can be placed on reverse side).
<br /> FOR DEPARTMENT USE ONLY
<br /> 'PLICATION ACCEPTED BYt_wi,-
<br /> VIEWED BY............................ ... .............. ...... DATE. �.'�G
<br /> .............
<br /> !LDING PERMIT ISSUED..............
<br /> ...................... ..:. DATE.........-....
<br /> .....................................
<br /> erafions and/o e m endaf'ans:............................... DATE......... _...
<br /> . ....-.._-.,t• ..�,<C......................�,a .::::::. ::::::::::::::::::::::::::::::::::::....::.::::::::::::.-......._.................. --•-
<br /> ................... ... ..... .................._.................... - ...
<br /> NAL INSPECTION BY:. -.. ... ..........
<br /> ............................ Date ..-,1�:.���.�'................
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> roar s.tas,.11.r,A,,..
<br /> 300 west Oak Street 124 Sycamore Stmot
<br /> 51041411,California Lodi,California 205 West 9th Serest
<br /> Manteca,California
<br /> r v,cc Tracy,California
<br />
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