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� <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> �� ~. <br /> JO <br /> ~�L <br /> �� ----- <br /> (Complete <br /> '- <br /> (~~^r~'~ Yn ~~r�~'~/ Date Issued .7__ <br /> Application is nnbm made to the Sun Joaquin Local Health District for o permit to construct and install the work herein described. <br /> This application is madewith County Ordinance No. 549. <br /> <3H ADDRESS A ''^^''--'------'''---''--'' <br /> Owner's .,~.~~��="��~.-'-.�.-�~=--~. ---------------.-' Phone--.-'_-------' <br /> Address-----.------_'-------------------'--------------------------------------------''-''--- <br /> Cnn racto/o Noma-_- --_._-_--.-----------__--__-.--_. Rhone-.__----___ ' <br /> |mstailation will serve: Residence �� Apartment House � Commercial F] Trailer Court ElM | OtherF]/� ' <br /> Number of living units- Number of 6o6,00m, ---- �Aum6nr of baths -I-X"t x�e _- � _---._ <br /> Vafor <br /> Supply: Public system Conmunity system [] Private []' Depth to Water Tu6�e --- ft � <br /> Character of soil ^to e 6-'- - - feet: Sand [ Gravel E] Sandy Loam El Clay- Loa- E] Clay [� Adobe-0) [] ' <br /> J <br /> Previous Application k�°6o Yes [� N New Construction: Ye,�� No [] . | <br /> ' '����� � �~ <br />. TYPE Of INSTALLATION AND SPGC|AC�TONS: '(,JNo septic tank or cesspool permitted if pu�lic sewer.is available <br /> within 200 feet.) <br /> Senpt�lc TankP Distance from nearest well_�/,f'�_.eDistanc f f dafion-APO.-material--- ---- - <br /> No. of ~~^''~'^^~'' ----------f�-�����~'~''��`�-�r---Liquid --r----'�~---Capacity- ,_.,`__�~~�_ ' <br /> ' <br /> Disposal Field: Distance from nearest well------ from foundation--------------------Distance to noumot lot line-----.--` <br /> Nvm6u, of |ines------ ----------------------------Length of each line------------------------------Width offrench---_-_.-.-- <br /> Tvpe of fi|+e, material-------------------------Depth of filter material -'-''''-----Total length------------------------------------------ <br /> Seepage <br /> ''--''-'-''-_---'Snopugo Pit: Distance to nearest weL.---.---Didanuo from foundation---------- -------- Distance fu nearest lot line .___- <br /> [1 Number of pits'-'''-''''Lining material---------- ''' .....Size: Diameter-----------------------Depth_-''-'---''-- <br /> - : '~' Distance from,nearest well-----------------Distance from foundation <br /> `---------- --- -_Lining ~--,-__.''=~-` <br /> [] Size: Diumrfoc.��-'_���������---_Dopt -.._.-�_'-���.-��.----.�qui6 Cupuc��'_-_.__gu|,. » ' <br /> r ' ' -~-~- ' v . ,~ � ' - , -` <br /> Privy ��t n�o fromwuU''-'-'-'''-''''-''''�.D�tann, fnxm noon,� 6�k�ng'-'''--'--__.''--- \ <br /> [] Distance to noa ' |o+ line---------°-��----_I_-_-.�.._-.-'___-___---_------.. , <br /> Rpmp6ving and/or napai�ng '' <br /> ' - '- ---'-- '� ' -^��~�^* - ��'r��� ~"�` "�°�"=� ` -' ' <br /> ordinances,I hereb� certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> State <br /> � ; laws, and rules and <br /> f'regulations ' ' <br /> ��ne6L --------------------..�Owne, mn6/o, Contractor) <br /> p8°��� --_--___----._--.-.{'Fitle)._-------'__-- ------------------ <br /> (Plot plan. sho66g size of lot, location of system in relation towells, buildings, etc., can be placed on reverse side).FOR DEPARTMENT USE ONLY <br /> / <br /> | <br /> - . <br /> APPLICATION ACCEPTED 8Y'-'''��-'��������-'-_''_'-'''''''__-_''_-' 0ATE-��-���'-' -- - -��. � <br /> REVIEWED 0�--.__---------------------.--'_--.__----. DATE--_-_-_--'_.-�'-__-------- <br /> BUILDINGPERMIT ISSUED-------------------------- -------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:--- ' .__----_--.__'___--- � <br /> --__-'--'-_''''''---''--''-'-''-'''--''�__-'�'---'-__---''''_-'''-'-'--'--_-'-''--_-'__.-_-_'-_- <br /> --'—'-----'-'---'---------'------------------------------------- ---------------------------------------------------------------------'-'' <br /> --`-`-``---``````-```--'````-``-```--`----``---````--`---```--````-``-``--`------`-```-`-`--``--` <br /> .--'-''-'-_-''''-_'--'''---'----.-_--''---'''---''''''-_''''-''-'--''---''-''-''-'''--_.'--. <br /> FIN/\L INSPECTION BY:-----�-�����.-.----_--_- Dot�------��.. - ------JOAQU|N LOCAL HEALTH DISTRICT <br /> oo south America" Street 3DO West Oak street /32 Sycamore street m* North "C" street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised W-2 100 <br />