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ICE <br /> E: 47 <br /> ' ^7 f -^ ___J -` <br /> / <br /> v <br /> APPLICATION FOR SANITATION PERMIT Permit No. � <br /> � �u���� � <br /> _r r�~'��'= �D*t�1sued ..-Application is hereby made to the San Joaquin Local Health District for a permit to construct and Z�h t�erk�h rein-descfibecl <br /> �1l�1�y / <br /> This application is made in compliance �vith ounty Ordinance No. 549. <br /> At <br /> T,O, A;400 <br /> Installation will serve- Residence &0"A'parfmenf House Commercial F] Trailer Court E] Motel E] Other 11 <br /> Water Supply: Public system [] Community system [] Private nK&oth To Water Tabl0l.. Ft. <br /> -t,noroitru, C" "*tf"= cx=V". ur^~.ct;.. "Jo.^rrj -".",�UnJ -~~'^^/ "~~'"T J -�-/ <br /> Previous Application 'ade: (If yes,date-------- --- ------- No QQ~~ New Construction: Yas [� No m�~~FH�/VA. Yes �� N� 9�- <br /> TYPE OP |NSTALLAT|ON AND SPECIFICATIONS: <br /> � <br /> (N* septic tank or cesspool permitted if public sewer isavailable within 200 feet.) � <br /> Septic Tank:, Distan�e from nearest well ..Distancefrom foundation -Motmrio| . . <br /> eki ` No.. of compurtmontc--_. ------------Size._---___.Liquid dop�h---------------------------Capacity-.--.--._ <br /> : Distance <br /> D�t nco fn»m nauny� veU---_��D�+unca6nm fou"6o�on'-_'''--'Di�unc� +onuoro� �� kno'-'---' <br /> Nun`ber of lines---------------------------......Length of each line-----------------------------�Widtk oftrench--------------------- ------ <br /> -- <br /> Type offiltmr.ma+vriuL--------Deof of filter material -------------------Total length------------------------------------------- ( <br /> to �� lot <br /> Seepage Rt Distance to � 'n <br /> QO�~° Num6erofpH������-''''�ning ma+or�L'���x�f�rS�e� D�mo+e�'�ed --uopth�1u�m�._-'''- �� <br /> 4�~ <br /> -- � . ° <br /> Cesspool: Distance from nearest weK'''_''-Distance �om foun6ut�n-'''�-'-Uning mo+e,�L-''-'--_''--'_ M ' <br /> � Size� Diameter-------------------------------------- Capoc��---------go|s. <br /> _ <br /> _ � <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building---_-__------ <br /> [] Distance +onearest lot line- -` �--- � <br /> ` <br /> Remo6��ng un�/o, ropoir�ng (da�crbe)�--��-. -- __-___._.__--.---_--- <br /> -------------------------- '-'-'''-''-_''-'' --------...... ''''_ ------------------------------------------ �'--''''_-'''-''-'-''-'--'''-''_------ « <br /> ----------------------------------------------------------�_..___. ------------------------------------------------------------------------------------------------------------------------------------------------ <br /> .______�___________.__�._____.----._-.___..___-__-__.---_-�-'----'--'-''--'''-'-''-- / <br /> hereby certify that I have prepared-this application' n6 that the work will be done in accordance with San Joaquin County ` <br /> ordinances,. ..~.~ laws, and,rules _- regulartJons of the -_ _-`_. ----1 Health District. . <br /> (Signed)---------- -------------- --- ----- ---------------------- <br /> By ---------------------------------- <br /> '-"(Plot plan, showing size,-of lot, location of system in-r on to w Ils, buildings, etc., can be pl <br /> /\PPL'� |ON ACCEPTED BY-------' ------------ DATE_. ------------ <br /> REVIEWED <br /> �-_-REV|EWBD 8Y../�''-'''-''_----'-_'''-____'-_'__________________ DATE_______�_____�___________ '. <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------"'^ <br /> DATE' ------------------ ------------------------------ <br /> nmnL INSPECTION BY -`----~-'----------- ---------��� / <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> 1601 E.Hazollom Ave. ' ' 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> / <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ,° 9 "E°S*= E3'^9 "" s'= "�=� <br /> ` ' <br />/ ., <br />