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-, <br /> / . ~~ /PLI_ATI-N FOR SANITATION P _~ iT Permit No. <br /> � Duo�m�\ <br /> (Complete Duplicate) Do+o Issued --- <br /> 0 ' y <br /> made to the San Joaquin Local Heo|+k District for m permit to construct and install the work herein described. <br /> This application i, made in compliance with County Ordinance No. S49. <br /> � �� � �� ^�] <br /> JO8 /\DDRESS AND LOCATION ��'�'����'�'�����0 �/��--��---' ~ �' UX���---- <br /> Owner's Na - -P\'� ��)' i _ _ P�one � <br /> � <br /> � _ � <br /> - <br /> Address ----- -----��-_-._-- �- -._--_--.. <br /> Con+mcto�s Name,-.-__----.-- � � �I � - ._.--- Ph .- <br /> Installation will ;vnm: Residence �~��po�ment House E] Commercial �� Tmi|or Court [] Motel E] Other [] <br /> Number of living vn��r ' Number ofbedrooms .~7�+~Num6er of baths ' ' Lot size »�r~�~-�---------------------~~~-_-' <br /> Water Supply: Public system Community system El Private R Depth to Water Table .5-Vft. <br /> " <br /> Character of soil tou depth � ] feet: Sand E] �GravelGravelE] Sandy Loam � Clay Loam [] Clay O Adobe ���nordpan El <br /> Previous App|icaf ion Made: Yes[] NoE] New Construction: Yes[] No [] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ^ <br /> (No septick or cesspool permitted if public sower isavailable within 200 feet.) <br /> Distance from nearest well------- ------Distance from foundation--------------------Material ----------------- <br /> No. ofcompartments--------------------- ----Size-------------------------- --- Liquid 6op�h--------------------------Capacity---__-'- <br /> Distance from nearest we|L-----Didnnce from foundation------Distance to nearest lot |im�.-_--- <br /> Num6,r o[ lines-----------------------------------Length of each line------ ------------ ..........Width offrench---------------_----' <br /> Type of filter material------------------------ Depth of fi|h:, material. Tot | length---'---_-_--_- <br /> : Distance to neu .......--------V .-W <br /> �� � �� - <br /> Num6erofpi�' �---' Lining mu+o�ui —����� D ��Dep+h' ---'-- <br /> ' <br /> Cesspool: Distance from nearest well--- from foundation ------ Lining material --__----_.. <br /> 0 Size: Diometec------ ----- -------- -------'------- ----------------Liquid Capacity............................ . <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---'_-'--__'_--- / <br /> [] Distance to nearest lot line -_-''--_ --------------- --------------------------------- -------------------------------------------------------------- <br /> /~�~ � � / �o � <br /> komodo|ing and/or napoi,ing (Jnscri���==~�--�' +'���m�u�-'\��n��k4��� ..____'--_____'__� <br /> � <br /> --- --''---''-'-------'-----'---_'_-''—'''_-.---__-`-. -__---.—.. <br /> -_-_-_�---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- __--_---. <br /> ' -------'---------'------------''--'--------------'--------' -----------------I hereby c 4-, Ila+ I have prepared t6,1&.,. li ationpnd that the work will be done in accordance with San Joaquin County <br /> r"'s, S1.7 -1 n Joaquin Local Health District. <br /> rid reg 0 <br /> ordinai S, and rules ai of f/I q11, <br /> �X� — <br /> IV ontrad or) <br /> By:------------------------------------------------------------- ----------------------------- 141;�--------(Tif le) --- - ----- -- ----------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to W buildings, etc., can be p ed on reverse side). <br /> -------------------- ..... <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ - -------------�­]_:'­�-------- -- - ------ --------------------------------- DATE------- —--------------------------------------------- <br /> --------------\_­� <br /> ----------------------'-----'-----------'--------------'—'--------'--------' <br /> /�� ` � ��-- <br /> FINAL INSPECTION 8Y:_�-� �-_---������� �� ��------- Date_ //��--�~ --- ----- <br /> SAN JDAQU|NLOCAL HEALTH DISTRICT <br /> oo s".* American Street 3ooWest Oak s~.°et 132 sr"m°," Street ow North ''c'' Street <br /> Stockton, California Lodi California wm"*"". California nra"r. California <br />