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APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) Date Issuej5 P/-�D <br /> gA ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> plicaf <br /> is application is made in compliance with County Ordinance No. 549. <br /> w��� ! <br /> JOB ADDRESS AND LOCATION--- .��-.^--'__��'��'— '� �-'—�r��------'-----'' ' <br /> Addres� . ..��_''--'--__--_-_'_.__._-_______-_ � <br /> Phone ' ' <br /> Contractor's N --�n��p�.-'° _.----- ��..-^�.^^-*"=.`�.. <br /> Installation will serve: Residence E] 'Apartment House Commercial E] Trailer Court F Motel [3 Other 0 . <br /> ^ <br /> Number ofliving units: Number of bedrooms Number of baths -1---- Lot size -�='''-K---t-j'---------- <br /> Wafer Supply: Public system E] Community system 0 Private to Wafer Table 3-6- ff. <br /> Character of soil to a6epth of 3 feet: Sand E] GrawdE] Sandy Loam E] Clay Loam 0 Clay E] Adobe E��urclpan0 <br /> Previous Application Made: Yes E]` No [9-~-1qow Construction: Y=s [j No p�--~--- <br /> � <br /> TYPEOF INSTALLATION AND SPECIFICATIONS: -` <br /> (No septic tank or cesspool <br /> �~nn|#�e-6 if pu6||* mo*or is available within 200 feet.) <br /> Distance from nearest .�D|dnoc� from foundation -�Material . - �����Saptic Tank: <br /> ` <br /> | Nof. of compartments- ----------------------.Size--------------------------------Liquld clen+ <br /> ` _------.Copudty_----._ <br /> � osal " �� Dincofn,� noona� weD'--'—���tmncp from foum6o�nn-''--�-'Didnncnfp nooro� �� |in�----------------- <br /> r <br /> --'-'' <br /> [Nu� 6er oi|noy � LangH` of ouc� |�na.---------�V�6H` of tmnck-----------.. <br /> ��p�e off +or <br /> mn+;ria�.'''-'''_-'-Depth of filter material �--.'''--Total length--- ` <br /> F Soo Pit i�anm, to noa,o� weU'�.����."-D6foncu from foundation �^� 01 +on�nn,� |ot |�ne...��'" <br /> Seepage Number of pits-------/'----.Lining mmterjo| izn-. ------------------- ' <br /> � . <br /> ^ Cesspool: D��nce from �oan:� weU--'----Di�uno: 6om foun6�6nn—�---'-Uning motn�nL--'-''-''--'-- ' <br /> Sb�� Di*mo+er..,----.~__----Deo�-----------.=----.Uqv;6 Cupac|iy-,-------...go|� � <br /> �~ ^ ^ ' � -_ ~ �- <br /> Privy: Distance from neurudvek'—''''_'---''�-''---D|�ance from n6nr�t building------------------------------------------ <br /> Distanceto noo�e, |o+ line----------------------------------------------------------------------- ---------- ----------------- ---------------------------------------- <br /> Y° <br /> Romodoing un6/or re <br /> ling -^ ---------------------- <br /> ------------------------------------------------- _-------------------------------------------------------------- <br /> ' ------------------------------------ -----.__.-_.'__-_---'--_-___-----'___--_.''''---_ - -'-----'--'-'''---- ------- <br /> | | certify <br /> ' nmd this application 6 that the work *U be done in r6 with 5a J �n Cou <br /> � wrJinmnces, State^=~~/ ~~^'|' ^'mn6 ru|omm� | km"o and p'-'-egu|mHmnmof�'-|fe �!ww Joaquin Local Health District. <br /> � \ <br /> ' (Plot plan. showing size. of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> | /\PPL|C/g'|C)N ACCEPTED 8Y'--'' ------'-_-__.--'- DATE-- <br /> ------ ---------------- <br /> -- <br /> --. <br /> ' REV|E��BD BY-----._—_-----/����/���--_---_--.__-___- D/�'E-.�---�-_^�_.��..��—__-- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------- ---------- DATE---.__-_-_----._--- ^ <br /> Alte,u+ion^ and/or recommen6afions;---------------------- ---------------------- ------------------------- ----------------------------------- _ --------- --------------- ''--------- <br /> ---------------------------------------------------------------------------------- ________--_'-_--''---''--''''-'-'''--'---'---'--'--'---'---' <br /> ------------------------------- ~�����������������������������--------------------------------------------------------------------------'-----------------'' <br /> ---'''--'''---'-'—' i[ ' ' --'''-_'''-_-'---''--''''--''�'-''-_'`''-'--------'--- <br /> � '-''-''—''''--''-'_'_- '''--'---'--- ----------------------------------------------- <br /> FINAL <br /> -''-'-''--''-'-' <br /> � <br /> ' �N�L INSPECTION 8Y�'_ ` --- Date ---,��L�/ ---------_-_.- <br /> � / <br /> ` / JOAQU|N LOCAL HEALTH DISTRICT / <br /> mu south American Street 300 West Oak street oz Sycamore street m* worth "C" street <br /> ' S*==kt"". CJx",";a Lodi, California Manteca, California Tracy, California <br /> ` <br />