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1� <br /> APPLICATION FOR SANITATION PERMIT Permit No. � | <br /> ^ <br /> (Complete � Duplicate) Date /,ove6~ -'�-'/~����i <br /> -. <br /> o| &hvyu6eto the Sun Joaquin Local Hno|+h District for o permit to construct and install the work herein 6o,cr\6e6' <br /> This application s made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION <br /> --------- __. <br /> 06 <br /> Installation will serve: Residence Y Apartment House E] Commercial E] Trailer Court E] Motel El Other L] <br /> Number of /wmg un//o: _/_- Number of bemnmms .a�:. Number of baths J-- Lot size _'x -�'-_-_-- � <br /> Water Supply: Public system E] Community system 0 Private,9 Depth to Water Table <br /> Character of soil to depth of 3 feet: Sand Ej Gravel 0 Sandy Loam E] ClaAdobe OC Hardpan E] <br /> Previous Application Made: Yes E] No X NewConotru��nm� Yes �] Nn �] <br /> ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: '. <br />� (No septic tank or cesspool permitted if public sewer ivavailable within 200 feet.) <br /> Septic, Tank: Distance from nearest well-----------------Distance from foundation-----__- L---_---.-------_-- <br /> C- Z; S�/I No. ofcompartments--------------------------Size------------------------------'Liqui6depth--------------------------Capacity--------' <br /> Dispnsa| |d Distance from nearest well----------------- from foundation--------------------Distance to nearest lot line----------------- <br /> Number of <br /> .__----Numberof lines-----------------------------------Length of each line------------------------------Width offrench_.'_-'�'__-'-__ ~ <br /> » Tvme offilter muferinL-----------------------Depth offilter material -_-------Totm} length------------------------------------------ <br /> Seepage H+: Distance to nearestwell- <br /> [� *uyp <br /> - .0 n �"� 10 to e_�0~~' <br /> °.R� Num6orofpifs-'�&-- L7ning nDiameter-Z-6.' -Dap+h..Z �' _ --� <br /> Ces000- Distance from nearest -__-_- u�o ----- ------------- Lining material _---._.___-_ <br /> 3ize: Diamoter'-''--'-'---'-__.Deuth----------------------------------------------------Liquid <br /> Capacity-.__--._. <br /> Privy.- Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- <br /> El <br /> -----__-__'`-__-[] Distance to nearest lof line---.--_----_------__.__.___.___.______________._^--___ <br /> Romodelingand/or repairing (describe):-------------------------------------------- ---------------------------------------------------------------------------------------------------------- <br /> --------------- <br /> ---------------------------------- <br /> ---------- <br /> ---------------------------------------------------------------------------------------------------------------- <br /> -------- <br /> -------------------------------- <br /> -__-____.___.__---_-________-__.__-_-.___.--_-'___-____---_--__..__-___-___--- <br />, --'-'___.______.__--___.____-____'.-__-_-.__-_-.__.-_-___---__'_-.__.__---___.__-_ <br />� hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />� ordinances,. ' State laws, ".""""^ ~~�� <br />� <br /> (Signed. �~ . _'''''-''''''---'-' `_- <br />~ <br /> By <br /> __________�_._______._____ ---------------- <br /> (Plot <br /> ____ <br /> (P�t �an, 6`�p�`g |pt location of syst em in relation towells, 6uildlngs, efc, can be placed on ,evnma u;6o), <br /> FOR DEPARTMENT USE ONLY <br /> APP [CATION ACCEPTED <br /> RB/| WED BY--------------------------- <br /> 8U!LD|N(� PERMIT |SSUED-_--- ��,_"-.-../2��.��SIP�------.-------------------- ��TE-�r.��.��. ~ ���r---_-. <br /> Alterations and/or ,ncommemJw+ions ----------_'--- -------------_____----_-�-�.__'--._--._-----._..______ <br /> -__.-'''_-.''�'--�'_�''''''----'''_''''-��--'-----''''_-'''''-_-'''-�--'''''-'''--__--_-___'''-_ <br /> ------__��--__------------------------______---------_�__---____----________---____�----- --_------''---_____---_---___-------_-----------__------'___-----____-------- <br /> ------__------'---------'_---__��--_�_-------______----- ------------------------ ------ --------------------------------------------------------- --__-----____-------___�_--____---------' <br /> -----------`----'�����`--`---```---``````------'``�`�����---``-------````` ``````---``````���````--```-------``---````���````--------'`------'` <br /> 4�7 <br /> W <br /> /j ` — �---------------------------------------------------------- <br /> SAN <br /> Du+o� � - -------------------------------------- <br /> FINAL <br /> ' INSPECTION DY ''''-' <br /> SAN JC)AQU|N LOCAL HEALTH DISTRICT <br /> moSoufh America" Street 300 West Oak Street /32 Sycamore Street ow North "C" Street <br /> sto"*"". California Lodi, California Manteca, California T=cy, California <br /> ES-9-2M 8'51 un./,°6 vv'x/ou <br />/ <br />