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- LIXAPPLICATION FOR SANITATION PERMIT Permit No. 0.0.............. � <br /> | <br /> (Complete in Duplicate) Date Issued <br /> pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made' in compliance with County Ordinance No. 549. <br /> .~-`.- <br />/ <br /> Owner's ....~ ^4.- ------+. --- --------------- <br /> .. . ..~.. - --' / <br /> Installation will serve: Residence [�I *pammentmo�� U u,mmemu| U /m/le, Court U Mmo/ U Other U � <br /> Number of living units: J- Number of bedrooms Num6e, of baths -J-.. Lot size - ' -����.�*.�^8.o�.^ --' ` <br /> o� t _*~^ Tu � <br /> Water Supply: Public system CommundY ��m E] Private E] Depth fo Water �rTu� '��- ft � <br /> / <br /> Character of soil toudepth of 3feet: Sand E] Gravel E] Sandy Loam E�—CloyLoam ' Clay E] Adobe 0 Hardpan El - <br /> � <br /> Previous Application Made; Yes E] No rF­ Nu~ Construction: Yes *-No 0 v\ � <br /> ./ <br /> TYPE {}FINSTALLATION AND SPECIFICATIONS: � <br /> (No septic , <br /> Septic Tank: Distance from nearest vur*nr= from foundation + m= "vo'ena. y_o�/m°��,��cc�r <br /> �—� No of � � . | <br /> ' "' 'p"'^^~^'^ ~� ~'^~ ^^ ~^~ ~^ � L'q~'~ ~`p^' `" ~~,~~'/ ~~ ~ ~ � <br /> Disposo| Field: Distance from ||i1**-_Ci Distance from foundation' Distance to nearest�--� lot <br /> '� <br /> ! <br /> 6a � | o� of � | � �� Width of � �� <br /> � <br /> ------- <br /> Type of filter mo+e,io � 4 - Dep+� of ��er mut�rio � � � � <br /> e� <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------Distance to neurusf1o+ |ine-- --------- <br /> Number of <br /> Num6arpF pits----------------------Lining material----------------------- Diameter------ Depth <br /> Ce0000 : Distance from nearest^well-----------------Distance from foundation''--''-'Lining mutoMnL''-�--'_-''-'',~� <br /> SizeDiameter Depth------------------ ---Liquid Capacity | <br /> ' <br /> Privy- Disfonce rom r�*nc,fwell-------------------------------------------------Distance from nearest building-------------- ' <br /> Dist*no, to nearest |p+ hne ---------------------------------------------------------------------------------------------------------------------------------- . <br /> / \ <br /> Remodeling and/or ����ng k6osc����'-'--''--�'--''-'''-'''_-_-_-'__'-_-'--_--'-'''-_--'''-''-_'--''-' ` <br /> -_._-__-.__-_-_-..__.-__-.____.__.`__.__,______-_-_-'_!-__-.-_---_.-__---_-_. ` <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- ------- � <br /> � <br /> ----------------------------------------------------------------- '_--------------------------------------------------------------------------------------------------------------------------------------------...... <br /> �~ . <br /> . h k application 6 t6 the work will be don �� ,6 with Su � �nu <br /> ordinances, State District. <br /> � - <br /> .+�) � <br /> ` <br /> } oy�- ------------------------------------------------------------(Title) ,�-�- � <br /> ! (� ��' �� � of lot, �� of system � �� � w� h��� �� � � p�� � re � �� � = , <br /> \ � <br /> � . � <br /> APPLICATION ACCEPTED BY.'_''- '--'_-'''---'-_.'''-' D/RE.''' --- <br /> REY|E�/BJ DY'---__-----�����- ----------------------------------------------------------------- DATE--_'�~�'�-��.��-��__-­ <br /> BUILDINGPERMIT |SSUED'-_''-''''--''''-'----''_''-'_-''''-'''-''''-- DATE-----------------------------------------------'_-'- ` <br /> ' ----_ - _ --_' <br /> ' / <br /> ...... <br /> ------------------------------------- -6f, ' <br /> -�r. _---------�-Fall ����-_''--. . <br /> ~ - <br /> �v------------------------------------------------------------------- <br /> ~�0-~~--'--°-'--''----v~------- ` `=-'`'---T---`-�'-- ' ' ----------------------------------------------------------- <br /> FIN/\L INSPECTION BY:------ ------------- Date-------------- -- <br /> -------- -----------------------------------------� \ \ <br /> \ <br /> SAN JOAQU(NLOCAL HEALTH DISTRICT <br /> /mo sv"m American Street am West Oak Street /sz Sycamore St=et ^ m* w"*h 'C' Street \ <br /> Stockton, California Lodi California Manteca, California Tw"r California <br /> ' ss-9-2w1o^2Revised v*-7/00 <br />