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` <br /> � <br /> APPLICATION FOR SANI TATION PERMIT Permit No- - <br /> \- k�om��o � <br /> * `--`- Duplicate)- Dmfo Issued �� <br /> ��� <br /> f / ' <br /> Applica4-ion is hereby made to the San Joaquin Local Health District for o permit to construct and install the work herein described. <br /> This applicationis made in compliancewith County Ordinance N <br /> __-L <br /> --------------- <br /> Installation will serve: Residence House [-] Commercial E] Trailer Court E] Motel F] Other E] <br /> Number of living units: --/-- Number of bedrooms -,3- Number of baths ---/__ Lot size ---------------------- <br /> Water Supply:- Public system P---community system El Private Fj Depth to Water Table _�.o ft- <br /> Chara'cter of soil to a depth of 3 feet. Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay Adobe 2`<,rdpan F1 <br /> Previous Application Made: Yes E] No R---New Construction: YEL� li?< El <br /> TYPE CJFINSTALLATION AND SPECIFICATIONS: � <br /> (No septic tank or cesspool permittedif public sewer isavailable within 200fee+) ~ <br /> So k: Distance [ U M D f � C <br /> No. of c m;_ SiAXJiVAX_4jLi i6 depth -d-6. Capacif- |- . / - - <br /> ���x <br /> D�,� �r|�� Oisfun�o � - Distance from foundation. �/Z -'Di - - ---� - n' <br /> --- <br /> Number f | ��� Width f Pl <br /> Tvpe uJk|+er mohyrio � _-Depth <br /> of filter mote��L-^��-��.v-To+u| �mg+�.._"�.��-�_--__----' <br /> : Distance to nearest w�,--c/.-. <br /> - � � to nearest lot | <br /> + r/u| <br /> Number ofpits--. y---.-Lining mo � -Size: <br /> Diameter-..... Duof --- -------.. <br /> Cesspoo|: Distance from nearest well-----------------Distance from foundu6on- ------Lining material --------__- , <br /> 0 Size: Diameter-------------------------------------- -'''-__''-''---'''--'`----Liquid Capacity----------------------------gals. <br /> Privy: D�stonco from nearest well .- ----------------------------------------Distance from nearest building----_-'__-_-- <br /> n ' Distance to nearest lot-line------------------------------------------------ -------------------------_'--_-'''-''�-----''''-----_-_--' <br /> Rom ' e]i`n~ and/or repairing /6aszi6el:------ --------------- . . `��------------ ---------- ------------- _- <br /> ( } ' <br /> -----.-_-'`___'__.'-_-__'.'_-''--.'---'-_-''--.- �''--_�.''-__-''---'-_--------------------------------------------_.'- <br /> ------------------------------------------------------------------------------------------------------------------------------------------- --------------- ---------------------------------------------------------------- � <br /> ---------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -. � ^ <br /> I hereby certify that I have prepared this | d that the work will be done in accordance with San Joaquin County <br /> ordinances. State laws,.,ald rules and regulaflons of the San Joaquin Local Health District. <br /> ,-`,--r-- -- --------------------------------------------------- ' ---' <br /> -'_-..-__'--_'-'-_.-.-__--------.---------.-_--_----._` --,_-____'___--.--.------ <br /> (Plot plan. showing size of lot, location of system in relation to wmUo 6uU6ingo, etc., can be placed on reverse side). <br /> � FOR DEPARTMENT USE ONLY <br /> 8U|LD|NG PERMIT ISSUED------------------------------------------------------------------------------------------------------ DAT6---------_------._._ <br /> Altwratkonsmn6/mrrecommendations:------------------------------------------------ ----------- ------------------------- -__'__- ------------------------.-._.__.---.. <br /> .__-__-__-----.-_-----_--'_-----'''-''''''---''''---'''----''-__-_-''---________ <br /> '-''-'-''----_-''-'--'''_,'�'---'�,-'''-_'''-'''---''''---_''--.''-----''---'_-'-''-''--_._-''--' <br /> -----'------------'--------------'-------------'----'---'------------ <br /> '--'-'-'-''''''-''''- -''-'''--'''-----��'''-'--''''-''-'''----'''-''-'--'------ <br /> /7 .FINALBY:----- Date_ <br /> SAN JOAQUDN LOCAL HEALTH DISTRICT <br /> /30 south Arrierica" Street 300 West Oak Street /32 Sycamore Street o|+ North 'C" Street <br /> Stockton, California Lodi, California ^ Manteca, California n~cy. o°|ao,"ia <br /> ES-v-ow o",is°6w/-2/ou <br />