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APPLICATION FOR SANITATION PERMIT Ponn & <br /> / %�mmn�|m�' 0mOmp|���A <br /> ' ' Dufu (ssue6 �-������,��� <br /> gplica-�ion is hereby mm6� tn ��oSnnJ \ Loc�| H |�hD��Hc+fo, uperm� focom�ruct �n� |n�o||��owor� hem�n6n�cr6n�.'` , / <br /> Is <br /> application is made in compliance with County Ordinance No. 549. ' , <br /> � <br /> ------------------------- <br /> Owner's Name-------- -- - ----- ----- --------------------------------------- --------------------- -- ------------- PhonA& <br /> --------------- <br /> �/ � <br /> Contractor's N �� �_---------.-_-._._�-.. Phona���.*x �~������� � <br /> Installation will serve: Residence [] Commercial [] Trailer Court � � <br /> �� ' 7�' ^ � /�� ^ <br /> 'Num6e, of |��ng unifs� +^^.. Num�orof6o6nonmo �c.. Numb�rofbut�s .=�. Lot'��e -�..��-.��..,���-.-----_---' <br /> ~ _`.�� �°a <br /> �� �� �6Uc �� � co �n� ,�m � P�� � Depth � W��� ­� ft. ' <br /> Character of sail to a depth of 3 feet: Sand Gravel F] Sandy L� Clay Loam E3 Clay � Adobe � H <br /> � u��n 0 \ <br /> Previous Application Made: Yes E] Norn^�-mow (�nn,+ruc6on: yo, ;rmoEl ` ,- � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer isavailable within 200 feat.) ^� � <br /> k� �o ' --' ----!�! ----------- <br /> D |�� 6n �°~ <br /> ber of <br /> mm ' /� _ Length of each line-..----' Typo qf �H*rmoterim � - ' - <br /> Distance to nearestto ^�~ ^ <br /> � <br /> Number of pits—../------------Lining mute��LeAt_(A�_.Size: Dlonnotu�__A�.^--Deo+ - _---- 6~ <br /> Ce � <br /> �000 � ' Distance nearest Distance from foundation moh,6oL'^,'-''-''. '___- <br /> [� Size: Diameter-------------------------------------- --------------------------------------- Liquid Cupucity-----------------------.-go|s. <br /> Privy: Distance from nvalreo wel|'''_--�.' ''�_''--'-D;s+onc= from nearest building--------------------------------___ ' <br /> []� ` -` Diis�onco to nearest lot |�e -'''''''''-'''-�'--_ ----------------------- ------- <br /> -Remodeling and/or repairing (describe):-------------------------------------- ----------------------------- <br /> / -__-.---'-'+.____.______.____.. <br /> ' � <br /> '--'---------'-'---'--'--'''--------'----------''--''--'------''''---'—'—''-'----------------- <br /> ----------------------------- <br /> --' <br /> '--'-'`-'--_.'---''_-_-_-''__.__-_-' -_-''--.'--- <br /> ----_-----''---_.'--'_-----'_---- �- <br /> ---_.---.__.--.__-__..----__----'__-_--__----_._—_-_'__'----_�--__.--_--.------ ~ <br /> | hereby certify that I have prepared t6rs application and that the work will be done in.accordance with San Joaquin County <br /> ordinances. State laws, and- <br /> ules and regulations of the San Joaquin Local Health District <br /> , '- plan. showing— ^-~ of ~'' location of system in relation~ to wells,~ buildings,^ ^ ~'~` can be placed on reverse" =""+ <br /> i <br /> ' <br /> FOR DEPARTMENT USE ONLY <br /> ' <br /> -' <br /> BUILDING PERMIT ISSUED___.__---^----._-_--_-.---..,----__. DATG--.—_.___--'_--'--_._ <br /> *ne,*+m"smnu/or,rwcommondat�ns:--._-------._---_----.---___-_--_ . / <br /> � ' - \ / <br /> '--'-'-'-----''''''--''--''- - x���'' ---- ���''' <br /> ' ��m� � � ��l�-- ' -------_.___ <br /> '---�`�-'�,__-''----.''---'-�-.-'''-''-'�, -''-'''-_.---'''-'---''-j --' -------------- '----'_--_.---' <br /> ---� -----�--.----_._--_----'�,�-4�1��' - ---''--'--�'--'' <br /> --''--'-'---'''--'' ---'-'-''-''''-''''—''---'''��-'''----------' ' <br /> ~- <br /> , <br /> � - <br /> ------- <br /> FINAL INSPECTION BY: - ---- Date.......... <br /> ( / <br /> � - SAN JOAQD)N LOCAL HEALTH DISTRICT <br /> /30 South American Street 30D West Oak $,*et /sz Sycamore Street o|+ North "C" Street � <br /> s+"=kto". California Lodi, California Manteca, California +-Twr» California � <br /> 6~ - <br /> sS-v-- M / o°,is°a *cz/on <br /> `^ ~ <br />