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^1 � <br /> APPLICATION FOR SANITATION PERMIT Permit � <br /> ~ <br /> (Complete in Duplicate) Dufu |oue6 �6' <br /> Application is hereby made to the San Joaquin <br /> / <br /> | Healfk District for and installt6 work herein 6, c,ibod <br /> This application is made in compliance with County Ordinance o. 5 <br /> ' -------- <br /> Owner's '-^'~ <br /> ------------ <br /> � ___---------- <br /> �� <br /> ` Con�ac���s Name-------------- ---._-__-_--._-.._-�.__ Pk�no-.�."_.- ~ <br /> _ .^ . <br /> |n�uUu+�n *|U vo�o: �vs�en:e K Apartment House E] Commercial F1 Trailer Court Wo+e| <br /> Number ofliving units: )----- Number of 6a6nzum, 2 <br /> '[ ' N ---------------------- <br /> Water <br /> Supply: Public system � Community system EP�vu+° er | �| <br /> ,�� D �� fo �� <br /> Character ofsoil tomdepth of 3 feet: Sand [] Gravel E] Sandy Loam E] Clay Loam El Clay E] AclHardpan E] <br /> U PreWpus . ,,._-. ka6o; Yes [] 'N�� New C.uConstruction: No [� <br /> ' <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: <br /> (N* septic tank or cesspool permitted if public sewer is available ,vw*/n 200 +oo+l / <br /> | <br /> Septic Tank: Distance from nearest Distance from f9undafion__/6_) - N <br /> No. ofcompo6moot�-...^��----3�n��'��� Uqui6d��� pacify-- <br /> Disposal Field: Distance from nearest well------------------ from foundation--------------------Distance to nearest lot |i ' <br /> E] Number of lines-----------------------------------Length of each line----------------------------- of french'''--_-'_-'---_. <br /> Type of filter material-------------------------Depth of filter material----------------------- length'___-..___---_-Seepage ' <br /> � ' <br /> R+: Distance to 7 nvam` lot line--.-::5�'-- ' <br /> Number of pits------JL_-..Lining =nota -.6�e: Diometoc���_----Dept ��_--_. <br /> - N~~� <br /> �n=ppo|� �|d�ou, from nearest well----------------- from foundation muto�ai-'-_---_-'__- � <br /> ' El Size: Diameter-�--------_._--.__ ----------------------------------------------------Liquid ----------------------------gals. <br /> Distance from building <br /> 61 4Z��Z/ <br /> � ~ -� '''~'-' -~--'------^--�--'-'-T'~--------'--''''-''-----'----'='----------------' <br /> 1 ---�-�-----------'---'~^--------------''-'-'-'--------------------------'---------�----------' <br /> with San Joaquin County <br /> ordinances, State laws, and rule d regul loqwo e a o a in cal Health Distpie't. <br /> wrier and/or Contractor) <br /> (Plot plan, showing of lot, loc ion of system in relat on to wells, buildings, etc., can be placed on reverse side). <br /> , <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION /\C ---- ------------.-------_-.--_--_' <br /> � <br /> ----------- <br /> REVIEWED BY------------------------------ DATE <br /> 8U|LD|NEPERMIT ISSUED <br /> ---=--_- ' ��� D \/E--------- <br /> Alterations and/or <br /> ' <br /> AltermMnnound/or n000mmendutivos:-------------------- ---------------------- --------------------------- --------------�- <br /> --_-'----------.--_---_-.----.-_-----------_-------^__---------------`-~-�- <br /> -_---------.---------_--------_1__---�----_.--.----- <br /> - <br /> - <br /> i --_-----._..--._.__--._.__-----_-.__-_--__^--.___.._.----''--'--------,-___.__-____. <br /> -`--'`-````------`-``--'```---````-------'`-`--`````---``----``--'---`--```--``---``------`--`---- <br /> --''-'-_-�----_'--.''--'''-'-_''',_-''-_-'''---- _-__'-_''''_-''-'-'''--''-_'''--_-'-_-_'__.'_ <br /> F|N \L -' <br /> |N5PE[�|(JN BY - �u��- �_--__-_. <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /vu S*wm Am*a""" e=m souWest Oak Street /32 Sycamore Street ow North ^c'' Street <br /> ` eooktn". California Lodi, California Manteca, California Tracy, California <br /> _ <br /> 8-5/ x°vi=a vv-2/00 <br /> � `�`� <br />