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APPLICATION FOR SANITATION PERMIT Permit No. - \ <br /> � �m �upS�wfm <br /> (Complete Duplicate) Date Issued / ' <br /> [« � ' ' <br />| ` <br /> T�plicafion is hereby made to the San Joaquin Local Health Dist rict for a permit to construct and install the work herein described. <br /> '~~JOu ADDRESS AND LOC8Hl]m_^ .. ���..���-_1�/�.l�1�UX��--_---._-_---.. - <br /> �� ' -/4O <br /> Owner's Name--.+_^.�����.- [�L�...������� ' ' - . Phone-- <br /> ~--A6 —, --------- ---------------- -''-------- �-~---------- <br /> Address---------------- <br /> J,ao----_-' --..--_-__._______.._._._____..~_�_�__��_._�_.�_.�.____.__��..��.��_____-.____`__`.___ <br /> .-------------------- <br /> Contractor's Numo.�..����!���x��-----.--------_---.;--------_--------_--. Phone------------------------- <br /> Installation will ' , Residence E] Comi-nencia| [] Trailer Court Motel Other [] <br /> Num6nr.of |iving unHs:''/- Number of6e6,00ms.Y--' Nur�6or of baths /- Lot size �� 'YJ ')( '�' '------ <br /> � ^ <br /> Water Supply: Pu6i�^�y�om\�* Community oy,h�m [] Pr�ot�F] Depth to Water TuEJo '''' f� <br /> - ` . <br /> Character of soil to � depth �3 feet: Sand 0 Gravel E] Sandy Loam E] Clay Loam [] Clay Adobe o��n � <br /> Previous Made* Yes D No New Construction: -Yes E] No <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: \ <br /> /N� septic fan� pr ��ss| �*\ �en��#o� R public sewer 200 feet.) <br /> *" <br /> `Septic Tank: Distance from neure,+ °aU.X/A'a'KD[sfuncn from found9fion-1--611---Material . ----------- <br /> ---------Copmcity----Z_0_0 of compartments------ V..8Uou@ 6on+ --4-- <br /> Disposal Field: Distance from naurud wellDistance f ro.m,foundation----t--A-------- Distance to moonast lot |inu.-/�-1'.. <br /> Numbo, o{ | Length ofeach |i / <br /> Typo of filter Depth~ of filter mute�'|� �--��--Tofo| -'--- ^ <br /> Seepage Pit: Distance to nearest wo|��-�------------Distance from foundation---- --------- to nearest |o+ line- <br /> Cesspool: ma <br /> Distance from <br /> ' nearest well ',_------------------------------------Distance from nearest building----- --_''-'__._'-- <br /> /[] Distance to nearest- of1ino----------------------------------- ---------------_-'-''-_--''--'--''��_'________.______ <br /> � <br /> Romo6e|ing and/or repairing (daozi6w):------------------------------------------------------------------------------------------------------------------------------------- ------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------------------------__--__--___--_--_.--_-.----_---_-----------_-------_--_-------_--- <br /> � ---.__.---_-_--__._--__---_-_-__..___.___.__-_-__--_-._-___'_-`---.--__----- <br /> | hereby certify that I have prepared this application and that the work-will bedone in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations � +� San Joaquin ��|'H�h6 District. ' <br /> � ' " <br /> ��nmJL. ..x�+w����^���,�����-Jl.J4-------------------------- ------- ------------------------------------------ -----(Owner and/or Contractor) <br /> Bv-------------------------------------------------------------------------------------------- -----------------------------------------Title)----------------------------------------------------------- -- <br /> (Plot(Plot plan, <br /> xlan. showing size of lot. location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> . ~~° "^ ,`~.""""' ,~= ^^"^. / <br /> . . <br /> --------------- <br /> �_- ~ —�~-�-x-�m------''--r--'---~~-=='-' ' <br /> -----'--------'-----'----------------------- --'—'^---- -------------'--''------------- <br /> ---'-''--''-''--''---'' -''''--'-'''-- --''-'''---'''--',--'-''--'''--'_'-'''-''_-''-- <br /> ~ ° <br /> � <br /> FINAL INSPECTION BY:.. ----_------ Date----- <br /> � ~ <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT -' <br /> 130 South America" Street 300 Was+ Oak Street /32 Sycamore $free+ � . nw North "C" Street <br /> ` s*"ktv . California Lodi, California Manteca, California Tm*» California <br /> \ ss--9-211A .o'uu Revised W-z|nn <br />