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` <br /> FOR OFFICE UtE­ <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> � . <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the:w6rk herein described. ' <br /> Tkis application is made in compliance with County Ordinance No. 549. -3--5n, <br /> J� <br /> Y« ` <br /> ^ <br /> JOB r.uuncoo AND LOC OVt7- RW X ------/ ------�:�-------- AR-r po---- Uva <br /> Owner's Name--------- ._--^--__--_._~-_ ------------------ -------------------------------------------- . .__^'------- . <br /> Address__- F.:---.__3 '-' -'-33''e - ---------- --- <br /> Contractor's Nvmo.. ------ ��F-___ -�------------------------' Phone------------ � <br /> |nstallation will serve; Residence [3� Apartment House F] Commercial L] Trailer Court [I Motel [] Other [] <br /> Number of living units: .. /- Number of bedrooms /7 ~um6e, of 6u+h, I---- Lot size -- ------ � <br /> �� . <br /> W� Supply: Public system El Community ElP�� � D� � W�r ��o ��. ft. <br /> Character of soil to u depth of 3 feet: Sand 0---'Gravel E] Sandy Loam [] Clay Loam E] Clay [] Adobe[] Hardpan C] <br /> Previous Application Made: (If yes, ' ote---_--.j No -~'' New Construction: Yes E] No Zr~ pHA/VA. Ye, [] No E~~ <br />,~_---TYpE._OFINSTALLATION ANDSPtCIFICATIONS- <br /> (No septic '~^^ or ~`~^r~~' r~^^''~~ if r~~^~ ~~w~' '~ ~`~^~~'~ <br /> n1: Distance from ne^unasf well 5»�'' from foundation Y No. ofcomp°�mont^--'~2~--�---- _Liquid �opf�- Cupud+y..94�p�--.- <br /> ' -------- <br /> Disposal Field: Distance from nearest well--15,() .-Distancefrom foundation---- ........Distance to nearest lot line----- <br /> N /r-� V) <br /> umber - Vi6H` of / - <br /> Type of filter mmfe�aLfDepth of Cher mvtoriuL..��� .Total \, <br /> length-----�!��� ' ' <br /> ------------ <br /> Seepage Pit Disfance to nvmna,+weU Disf nc�v from foundation---.....:' Di,+nno, +n nearest lot |i*u <br />` ^"^"p"°` ="='`= from "6a'e" well Distance from '"°"°"''= Lining=" "'"^"''"' <br /> ^~''~~~~'g and/or repairing^^ r--~-/ <br /> I hereby certify that I have pre'ared this application and that the work will be done in accordance with San Joaquin County <br /> -fe laws; 'and rules apdo regul tions of the San Joaquin Local Health District. % <br /> ordinances, Sfa <br /> ----------------- <br />� (P|o+ p|m/ . showing size of lot, |ocati�n of system in ,o|at|pn to wells, 6uU6ings, etc., can be placed on reverse side). <br /> � <br /> FOR DEPARTMENT USE ONLY <br />� <br /> APPLICATION ACCEPTED QY------- <br /> -TTF._0----------------------------------------------------------------------- DATE.-- � -------------------- <br /> REVIEWED <br /> -----'kB/|EVVED DY-_-------------------------------------------------------------- --- -------- ---- -------------------------- DATE------ -----------------------------------------.. <br /> BU|LD|NE; PERMIT ISSUED------------------------------------------------------------- -------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or mecommen6a+ions-.--.--'-`--------------------------------- ------------------------------------------------------------------------------- -------------------------------- ~- <br /> -------------------------------------------------------------- ---------------------------------------------------------------------- ^ <br /> - ^ <br /> -'-� - ------------ ------- ------------------- --------- --------- -------------------------------------------------------------------------------------- ------------------------------------------------------ <br /> _--------------------------------------____'- --- ________________________________ �� -________ <br /> ��__�_ �� �__��___��___��____�___�___�_������_--------------_ <br /> -_ <br />. RN/\L |NSPEI�T �-\-.\^^�]C����� Date................. <br />� ^ <br />� <br /> SAN JOAQ0N LOCAL HEALTH DISTRICT y <br /> 1*01 E.o""wto"Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California California Manteca,California Tracy,California <br /> F.P.=. .. � <br /> ' <br />