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� <br /> APPLICATION FOR SANITATION PERMIT - Permit No. <br /> � Duo�m�\ / <br /> (Complete— — Duplicate) <br /> Date Issued _-./�����'.. <br /> Aouica-%niskere6ymode tothe 3ohJoaquin Local Health District mpermit toconstruct and install the work herein described. <br /> This application ixmade incompliance with Coun+yOrdinance No. 549. 61�� <br /> &� <br /> JOB ADDRESS /�NDUOc�/\T|ON--..X8aI1�..��,*-J�e/���-��0��JQP�..]iQ»d-'��..��.��- .»�.�&�� �' <br /> Owner's Namo-'lUIU�D�..��.^..]��tXl��--------------------------------------------------- -------------------------------------------- Phone_-I^od;L..!����-58 <br /> AJJmos--_-_-_-] _ _ ...... ------ <br /> Contractor's Name---.�5��l:r-w---W1Il.-��Q�l.O��'���l��%.��-����../��..�/���/��-�v�.l����.-........ Phone. <br /> -.-----'-'-_.... <br /> |nstallationwill serve: Residence r] Apartment House E] Commercial [] Trailer Court [] Motel Other <br /> Number of living units: ]L-. Number of bedrooms ----JL. Number of 6uHs -'2 Lot size .]' . --_-- <br /> Wafer Supply: Public system [:1 Community system [I private M Depth to Water Table ..__6.0 ft. <br /> Character of soil toodepth of 3 feet: Sand E] Gravel E) Sandy Loam X] Clay Loam 0 Clay 0 Adobe 11 Hardpan El <br /> Previous Application Made: Yeo [] No [R New Construction: Y=s 91 No [] Addition to old construction. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No septic tank or cesspool permitted if public sewer ixavailable within 200 feet.) <br /> SepticDistance from nearest well------A6------Distance from fovn6ution-]0--------_Material .-g_014DrQt��...0­5. <br /> . <br /> 5 <br /> �� ~rreonsj8n�xu. u� cumpm�m�n�o--.��-----Siz�.�«.��JLv-x5.----L|qvi6 6*p�-_JL°--_-.Cupmd�-_1 � -'Pq°�t <br /> Disposal F' ldD��nce fm� ����' Distance from foundation, 1a <br /> Ar Number o� lines .9 of each |� of trench........-2''1tix............ <br /> Type of filter mmterio|..rR .'D&pf6 of GKa, mnuta,iu|i?--- -_QWotal length-----_-'----'---'_-_ <br /> Sampugn Pit: Distance to nearest well . 'Distwnca from foundation . -Distuncoha nearest lot line. . '- ' <br /> � <br /> [] Number ofpits----------------------Lining material ._-.----Size: Diameter..--.----..Depth................................ � <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material .----_'_'_'------_ <br /> [] Size: Diameter-------------------- —._-- ----------------------------------------------------Uqui6 .-- __-_ <br /> Privy: Distance from nearest well ---'---__...................Distance from nearest building------------------------------ ........ ^- <br /> [] <br /> Distance tonearest lot |ine-.......................... ---------------------------------------------------------------------------------------- --- ' ---. <br /> Remodeling and/or repairing (describe):- New construction consists of additional leaching es <br /> '- -------''- <br /> 11 <br /> ie tank. New construction indicated on chart in n . <br /> --_----_---_---------------------------------------- -------------------------------- ------ --------........................ .............'..........-_--- _—'--___-- <br /> that the work will hedone in accordance <br /> ordinances. State laws.,And rules and regulations of the San Joaquin Local Health District. <br /> (Plot plan. showing sike of lot, location of system in relation to wells, buildings, etc.. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ------- <br /> BUILDING PERMIT ISSUED..... -------------------------------'�--'--_---------------------------------------- DATE-------------------_-__--__.------_- <br /> A{forahonoand/or recommendations:...............................----------------------------------------------------------------------------------........................................... <br /> .........................-------------------------------------- --------------------- ---------------------------------------------------------------'-'-------------------------------------- <br /> ------------------------------------------------------------------------------------------.................................................................................. ..................... ....................... <br /> ...........................................................................'- .......................................................................................................................... ............. <br /> ' <br /> ............ ------------- -'---' --- ----------'--' <br /> ~-^�� ~_ <br /> ^� ~ <br /> F|N/\L |N�PB��|Om --�����_��-�.���"�~.��'--^= �utm-..��-m�--1.,�-.��'+�---------.--'--.' <br /> SAN JDA{)U}N LOCAL HEALTH DISTRICT <br /> mn s="m Am°ricmn Street xnn `v°"+ Oak s�=.+ 132 sv""m",° Street o/* North ^o" s+,"°t <br /> Stockton. California Lodi, California Manteca, California Tracy, California <br />